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1�•1 ���? <br />'�.E'.,°`"� CO N ST R U�CT I O N►� ;1 <br />cin os <br />everett PE RM IT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION , ❑ COMBINATION ❑ BUILDING ❑ MECHq,NICAL <br />� V^' <br />� OE/S <br />1 <br />� �5E <br />`/ LEG <br />1i '-' <br />CONIR�CIOR <br />Mea•ooness <br />M41L <br />ZIP <br />❑ PLUMB�NG <br />Y�IVNC <br />'o�-�3S ��2.�' <br />vHOH[ /�^ <br />(7—' J l � <br />❑ SIGN I <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REP41R ❑ �EMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAtION <br />uo�� Or wonn iCosr Or uar[nu�� r�us uBo�i <br />,7z ,9Smo <br />IiBE wOR <br />^ul, n i/� �- �1Pi� � /�- i )ti �i -r k�� i <br />/ " G 3 �✓/�.� / � � "�7i"��- <br />O� PAOVERIYh SHOWN �ELOW OP A1iAC11 fOUP COCIE51 <br />7('!PI_. f'Ld i �J C/�l�� <br />33n <br />;� PROJEQ �UDRE55 + <br />�T�� '%, ( <br />� PLUMBING <br />NO. TYPE OF FI%7URE OR ITEIN <br />W�TER CLOSET �TOILET) <br />i <br />BATMTUB <br />� UVATONY (WASH BASIN� <br />SMOWER <br />J KITCHEN SINK 6 OISP <br />I OISMWASHER <br />� LAUN�RYTRAY <br />I CL0T1iE5 WASMER <br />� URINAL <br />ORINNING FOUNiA1N <br />� PLOOR ORA�N <br />� UPCKFIOW PREVENTERS <br />� ROOFDRAINS—RAINlEA0ER5 <br />i <br />� SINN �SERVICE — �FR. ETC � <br />f RONi SEfO�CM <br />,o_ <br />USEIOHE <br />/� < <br />ttnE or corvsr <br />��� <br />SiZE OF O100 <br />¢� ic� 3F <br />r <br />SUB TOTAL <br />VERMIT <br />TOTALfEE <br />R- <br />SiOPiE <br />z <br />ICRIION�CC [ir IP��HSCNECnE�Bv <br />v� Y1�1/ <br />�C Jr r n� ��� <br />�� � <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETFUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE� <br />IN OR NOT. THE GRANTItJG OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR ANCEI THE PFOVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW �EGULATING CONSTRUCTION <br />OR THE PERFORMANCE O,F* CON�TRUCTION. . <br />SIGNAT��pE OF C/O�lYPACTOR O�AUT�IpPo ED FGENj �ATE <br />NO <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A/C — A/HNOLG UNITS — M.P. <br />Rf:FRIGERAiION UNITS — HP. EA. <br />Q BOILERS—B.TL/N.P. <br />GAS FIRE� A.C. UNITS — B.T.U. <br />FORCED Alq SYSTEMS — B T.U. M <br />^� WALLHEATEFS—B.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPpRATIVE COOlERS <br />CLOiHES ORYEf1S <br />V[NTILATION FAN <br />RnNG[NOOD <br />WATERMGTEfl . <br />WOODSTOVE <br />METAL flFEPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEATPUMP <br />�AS PIPINO <br />E%HAUSTFAN <br />� <br />VRCRNi SILE <br />❑YES ONO <br />NO OF DW[IUNG UNIiS <br />� <br />M�% OCC LOAD <br />zQ <br />FEE <br />� 9UBTOTAL <br />PfR1AIT _ <br />TOTALFEE ) / / <br />P�AN CFI CK NUMBER FEE �� RECEIPT NO. <br />�B 1►��v ��a � <br />FEES VALUATION FEt <br />BUILDING s��Z � �- <br />7LUMBING CJ <br />MECHANICAL f ( <br />OTHER /Q <br />STA7E BUILDING SURCNARGE <br />STATEENERGvSUPCHnRGE � <br />PUBLIC WOFKS <br />TOTAL ' � <br />PROPERN OWNERS ARE RESPONSIBIE FOR DE7ERMINING ALL <br />PROPERiV LINE LOCAilONS AND RELATED EASEMENTS. <br />