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i:j� ll ."�l <br />,,.E�.,,,,,� A�PLICATION FOR=� <br />��TM�F CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />i <br />everen <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWHER � FIAIL�O�RE54 GIY $IV PIIONE <br />MR�mc1�Qc�asve[e��te r�a�l.L��„e�� �� Gvr�R �r 9gaa3 �SS-»,9� <br />��., <br />PWMBINOCONiRAC10R MNL��DRE59 CITY 21P PIIpNE LICENSE• <br />❑ NEW ,�ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO RELOCATION <br />FROJEGT�ODRE55 <br />�� <br />PLUMBING <br />NO. TYPE OF FI%TU <br />WATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORV�WASHBASIN� <br />SHOWER <br />NITCHEN $INK 6 DISP. <br />CLOTHES WASHEN <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN ' <br />BACKFLOW PREVENTEflS <br />ROOF DRRINS — RAINLEA�ERS <br />SINN �SERVICE — BAR. ETC.) <br />SU8 TOTAL <br />PERMIT <br />TOTAL FEE <br />�NSi. OLGUPRNCYGaOUP <br />4 N IZ- 3 <br />/49 -s F. <br />T <br />� <br />f <br />f <br />sme sere�cK <br />6� <br />V�CANT $ITE <br />OVES �y0 <br />NO.OF DW � INI <br />MAx. ocC LOAo <br />n/,�J <br />i "",i I /3CJP� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL 8E COMPLEiED WITF! WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SVNA � �C�TRACTORORA�ITHORIZEDAGENT �OATE/� ^� <br />A i' i s'" <br />�:, <br />NO <br />MECHANICAL <br />A/C — A/HNOLC UNITS — N.P. <br />REFfiIGERATIOft UNITS — H.P. I <br />BOILERS — B.T.U./H.P. <br />GAS FIREO A�C. UNITS — B.T.U. <br />FOHCED AIR SYSTEMS — B.T.U. <br />WALL HEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />CLOTHESORYEPS <br />VENTILATION FAN <br />RANGEHO00 <br />WATERHEATER . <br />wOOD STOVE <br />67fi'fAl. PIREPLACE d CHIMNEY <br />HEAT PUMP <br />OAS PIPIN� <br />PLAN CHE K NUMBER <br />�'�s �1��I5y <br />SU970TAL <br />M EA. <br />M <br />M <br />FEE <br />AL FEE 3� I <br />FEE � FECEIPTNO��� <br />� �(5 <br />BUILDING S <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE BUILDIN6 SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORHS <br />TOTAL <br />PFOP'eRN OWNERS ARE RESPON510LE FOR DETERMINI NG ALL <br />PROPEFTYLINE LOCATIONSAND RELATED EASEMENTS. <br />