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� APPLICATI�N f�R <br />�MEr�ryn�n ' ` CONSTRUCTION <br />urr or <br />everett PERMIT <br />RUILDING DEPARTMENT TO BE COMPLETED IN INK • PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION `�BUILDING O MECHANICAL <br />OWNER M�ILADORE55 C�iY [�ZCIP <br />.. . . I_ r.�.r 1 w._..e.,...� ' �/ILQtL� 70�(� <br />❑ PLUMBING <br />everetl <br />e� <br />❑ SIGN <br />r. <br />� <br />GENERALCONTH�CTOB M�ILPU� ESS Cltt 21P PNONE 4GENSE• <br />S U I � ` � <br />MEC ANIC�LCONTR�GtOq M�IL�DDRE55 Cltt ZIP PHONE UCENSE• <br />PLUMBINOGONTR�GTON MML110DRE55 GIiY Z�P PIIONE UCENSE• <br />• <br />IU�WV111� <br />NEW � ADDITION ❑ AI.TERATION ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPL.INSERT BUIIDING L <br />� � 0� ►LC�J <br />�or_ <br />iOJECT�0UFE5: <br />� �W <br />PLUMBING <br />NOT— <br />�AVATORV IN�ASH Bp <br />SHOWER <br />KITCMEN S�NK 6 OISP <br />DISHWASHER � <br />UUNORV TRAY <br />CLOTMES WASMER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN ' <br />ROOF DRAINS — <br />{PONTSE�TB��CyM <br />C.� <br />USE20NE <br />� Z <br />IYPE OF CONST. <br />S�-A/ <br />512E OF BLDO. <br />/ r� Gt)3b � <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETRUEANDCORRECT. ALL <br />F'ROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GFANTING OF A PERMIT DOES NOT FRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR i.ANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE P RMANCE OF C STRUCTION. . <br />SIGNA7URE O C NTFACTOR OR AUi R ED AGENT OATE <br />X.. . _� . .'../ %�3���jii <br />MECHANICAI <br />OR ITEM FEE NO. TYPE OF E�UIPMENT <br />A/C — A/NNOLG UNITS — M.P. <br />f1EFHIGERATION UNITS — H.P. EA. <br />BOILERS — B.T.U./M.P. <br />OAS FIRED A.C. UNITS — B.T.U. <br />FOHCEOAIRSYSTEMS—B.T.U. M <br />WAILMEATERS—B.T.U. M <br />UNIT NFATERS — B.T.U. M <br />EVAPORATIVECOOLERS <br />� CLOTHES DRYERS <br />VLNTILATION FAN <br />RANOEHOOD <br />N'ATERMEATER . _ <br />Sl1B TOTAL <br />VERMIT <br />TOTAI FEE <br />RSETB�CN <br />V�C�NT SITE <br />OYES ONO <br />NO.OFOWEL <br />��,�, ,� pLANSCMEGNEDBY ervn.ronc <br />� � �� <br />�j�la.t+.�bu6 o�wpa�d ll>av -Bl,4p =3Siu <br />� <br />d <br />FIREPLACE IN: <br />HEAT PUMP <br />6A5 PIPIN� <br />E%HAUSTFAN <br />� SUBTOTAL <br />PfRNIi <br />TOTALFEE I <br />%,AN CHECK NUMBER FEE AECEIPT NO. <br />!O d527$ II?�' ��� <br />FEES VALUATION FEE <br />BUILDiNG ��`'UU U S � � ( (J %li <br />? <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATEBUILDINGSURCHARGE L S <br />STATEENERGYSURCHARGE <br />PUBLIC WOFKS <br />TOTAL . �v <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DEf ERMINING ALL <br />PROPERTYLINELOCATIONSANDflELATEDEASEMENTS . �. <br />����� : <br />