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i <br />IM Er.rprrHn <br />LITI' OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />�T.*, <br />�r:'�'PLICATION FOk� <br />COfVSTRUCTI�N <br />PERMIT <br />TO BE COMF'LETED IN INK- PLEASE PRINT <br />�1,pEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />IAAIL <br />everen <br />� <br />❑ PLUMBING ❑ SIGN <br />PHONE <br />777 G 7t =iai� <br />vMONE <br />�i %\�� S/�J/✓ <br />GENERAIGONiRA�iOR MAIL AOORE55 Clry jll' IqipNE IICENSE • <br />Js9-1Miv <br />7�� � ��?R i�.y �S�'1 .JSv.37 ?,3n.�.4v� W. �v�rr�lv .�/FT�a lP�tto[3/bo v�I <br />MEGN�NIGLGOII�BAGiOfl MML���RE55 Cirv Ziv PNONE IICErvSE• <br />PLUMB�NGCONiRACtOR MaILAC0�E55 CiIV ZIP VIIONE UCENSE• <br />❑ NEW ❑ AD�I710N ❑ AL7ERA710N ❑ REPAIR �DEMOLITION ❑ WOODSiOVE/FRPL.INSERT ❑ BIIILDING RELOCAiION <br />DESCR�BE <br />PLUMBING <br />NO. TYPE OF FI%TL' <br />WATER CLOSET �TO�LET) <br />BATHTUB <br />UVATORY ; WASH BASINI <br />SINK 8 DISP. <br />UUNORY TflAY <br />CLOTIiES wASMER <br />UHINAL <br />ORINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENT <br />ROCF ORAINS — PA11 <br />SINK �SERVICE —BP% <br />�� FIRE SPRINKLER; <br />f <br />i APFlIC�110NPCC BY <br />1 <br />1 HERGBY CERTIFY THAT I NAVE READ AND EXAMINED TNIS AP� <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETh�cR SPECIFIED HERE <br />IN OR NOT. TfiE GRANTI�VG Of A PERMIT DOE5 NOT PRESUME TU <br />GIVE �UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSiRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. '/ <br />SIGNATUpEO�CONiRACiGRO11AUf110R�ZE�AGENi p4tE 7�'7.��r <br />X�_���..__ � <br />MECHANICAL <br />OR ITEM FEE NO. TVPE OF EOUIPMENT <br />A� C— �/HNOLG UNITS — HP. <br />R[FRIGERATIONUNITS—HP EA. <br />BOILEflS — B.T.0 /H P. <br />GAS FIRED A.C. UNITS — 8 T.U. <br />FORCED AIR S�STEMS — B TL. M EA. <br />WAILHEATERS—B.T.U. M <br />UNITHEAiERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES�RY'RS <br />VENTILATION FAN <br />RANGENO00 <br />WATER HEATER '�� <br />i5 W�ODSTOVE <br />METpL FIREPLACE 6 CHIMNEV <br />SUBTOTAL <br />PEflMIT <br />TOTAL FEE <br />vACaNiSrtL <br />❑YES ONO <br />OCCIIPANCYGPOUP NOAFOWELLINGUNIIS <br />CNEGNED BY <br />FIEAT PUMP <br />CAS PIPING <br />E�fHAUST FAN <br />S11B TOTRL <br />FEflMIT <br />ttAN CMECN NUMBER � F[E I AECEIPT NO. <br />FEES VALUATION <br />DUIL�ING $ <br />f'LUMB�NG <br />MECMANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STAtEENFRGYSUFCHARGE <br />PUBLIC WOHKS <br />TOTAL <br />PROPERT� OWNERS AFE RESPONSIBLE FOF OETERMINING AlL <br />PROPERT'/ LINE LOCAilONS AND RELATED EASEMENTS. <br />