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� <br />rn. er.ryr.�n <br />an oF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />r.PPLICATION FGl�. <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE FRIIVT <br />❑ DEMOLITION ❑ COMBINATION I$BUILDING <br />OWNEH M� ILADORESS <br />e�Rc;ani.a� LI�R�? �`c_!'on�.c-a�- ��:fi �'�f7i< <br />� <br />❑ MECHANIC��L ❑ PLUMBING <br />❑ SIGN <br />ME(;NANIC4LCONTR.�CiOH MAILAUUXLJ] I.�IT GIY YHONf �I[[NSEI(]tF <br />I� <br />PWMBINGLONiP4CiOR MqILADD"1E55 O�TV ZIP PIIONE LiCENSE• <br />CUSSOF WORrc <br />❑ NEW ❑ ADDITION I� ALTERATION ❑ <br />VAL�UNT7ION Oi W,—OP�e 1C�O5T OF MATEFIPLS PW S LA90RI <br />/�'x.t / N�vv�✓in10 �72'�2.CbiY=� <br />PLUMBiNG <br />ZONE <br />—� <br />I701LET1 <br />PAIR ❑ DEMOLITION ❑ WOODSTOVE/FRP�.INSERT ❑ BUILDING RELOCA710N <br />LOPiESI <br />OR ITEM � FEE <br />LAVATORY (WASH BASIN) <br />SHOWEP <br />KITCMEN SINK 8 DISP. <br />DISMWASMER <br />UUNDFY TRRY <br />CLOTHES WASHER � <br />UFINAL <br />DPINKINGfOUNTA�N ��— <br />FLOOR DFAIN <br />BACKFLOW ENTERS <br />ROOFOp S—RAINLEADERS <br />SINK RVICE—BAF.ETCJ <br />� <br />OFBIDG <br />Zi7r <br />orvncc env <br />�� / <br />SUB <br />�'� <br />VAGANT SIiE <br />❑YES UAO <br />PLRNSCMECNED BV APPR. FOq ISSl1�NGE BY <br />`�, L . G.. <br />1 HEReBY CERTIF`.' 1'H� I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW?HE SAME TO BETRUERND CORRECT. AlL <br />PROVISIONSOF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATUREOF����TO�F�UTHOBI�DAGENT� �ATE^ l <br />X / 1 � <br />MECHANICAL <br />A/C — A�HNOIG UNITS — H.P. <br />REfRIGEPATION UNITS —H.P. EA. <br />BOILERS — B.T.0 /H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCED AIR SYSTEMS — B.T.U. <br />WALL HEATLRS — B.T.U. <br />UNIT MEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTNESORVERS _ <br />VENTILATION FAN <br />RANGEHO00 <br />WqTER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPIACE INSERT <br />HEATPUMP <br />GAS PIPING <br />E%MAUSTFAN <br />f'�AN CH CK N <br />`-�;7� � <br />� <br />BUILDING <br />PLUMBING <br />MECNANICAL <br />SUBTOTAL ! <br />PlPMIT <br />T07�L FEE <br />FEE �- NECEiPT NO. <br />�-� �L�-�:.-' q3�� <br />OTHER <br />STA7E BUILDING SIIRCHARG <br />STATEENEHGYSURCHARGE <br />PUBLIC WOFKS <br />TOTAL <br />3 <br />� <br />PRC"ERiYOWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPEfiN LINE LOCATIONS AND RELATEU EASEMENTS. <br />