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'� tM Er�rpn�n . <br />'.un or <br />e��erett <br />BUILDING DEPARTMENT <br />2b9-8810 <br />��PPI_iCATION FO� <br />i.ONSTRlJCT10N <br />PERMlIT <br />TO BE COMPLiETED IN INK- PLEASE PRINT <br />everett <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDIMG ❑ MECHANICAL ❑ PLUNiBI�IG ❑ SIGN <br />�y��Eq MAILAODHESS CIiY ZIP PHONE � ' <br />• n„ , c�_. ._ ,-.. N2 I ��urr �.J ��•�t,�1-/"/' .2�-`I- IiG ? �, <br />OENERALGONTRACTOR MMLAO�RESS C��Y IiP PHONE LILENSE• <br />Notirti Jo� u I�ILU �1 J-uY u�� �i� 1�9qA�I✓�LL/' wr—� (. �-7 :L� �L <br />MECH�NIC�LCONTP�LTOq MML�DPRES9 Cltt Z�P PMONE LICENSE• <br />--4t^�-in� �i . rf-,c.�c—f <br />:L�SS OF WORK <br />il ucw Il� aDO1TION ❑ ALTERATION ❑ fiEPAlp ❑ OEMOLITION ❑ WOODSTOVE/FFPL.INSERT ❑ BUILDING FlELOCATION <br />w rr:�� r� rN — <br />�� 5'7/ 4-0 0..-. <br />'HOPERTY ISMOW N BElO W OR i <br />LOi_BLOC1t�� <br />PLUMBING L <br />Ho. rrae � <br />WATER CLOSET <br />BATHTUB <br />�AVATORVIWAS <br />SY.OWER <br />NITCNEN SINK 8 <br />r�:.i�rs� <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVIS�ONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIF.D 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 UR LOCAL LAW REGULAT�NG CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OF CONTHACTOR OR AUTIIORIZED FGENT OATE <br />.nO� I� � C�ITY ,SI�S�� NSE N� �— � � � � <br />MECHANICAL <br />DILET� A/C — A/HNOLG UNITS — M.P. <br />REFPIGERATION UNITS — M.P. I <br />BASIN� BOILEPS — B.T.U./H.P. <br />(iAS FIRED A.C. UNITS — B.T.U. <br />ISP. FOPCED AIR SVSTEMS — O.T.U. <br />WALL MEATERS — B.T.U. <br />UNIT HEATCRS — B.T.U. <br />CIOTHES wASNER <br />UR�NAI <br />BACKFLOW PREVENTEFS <br />ROOF DRAINS — RAINLEf <br />SINK ISERVICE — BAR. E7 <br />FRONT9ETBACN <br />yo , <br />usEzaNE <br />�� � <br />TVPE OF CON9T. <br />512E JF BL�a. <br />9UBTOTaL <br />( SIDE SET9�CK <br />� s� <br />V�C�NT SITE <br />�U O �YES ONO <br />fFOUP NO.OFOWELLINOUNITS <br />LO�D <br />Br <br />VENTILATION FAN <br />HANGEHOOD <br />WATER HEATEF <br />WOOD STOVE <br />MEfAL FIREPLICE 6 CHIMNEV <br />FIPEPIACE�NSERT <br />HEATPUMP <br />GAS PIPINO <br />E%HAUSTPAN <br />9UBTOTAL <br />PLHMIT <br />TOTAL FEE <br />��c�iR��b �F��7� <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDIN6 SURCHAFG <br />STATEENEROYSURCHARGE <br />PUBLIC WORKS <br />TOTAI <br />M EA. <br />M <br />fiECEIPT <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PflOPER7Y LINE LOCATIONS AND RELATED EASEMENTS. <br />9 <br />