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`,.PPLICATION FO'�,.° <br />;�� Ewrprs�n C O N ST R U CT 1 O N <br />Cltt OF <br />everett PE:RMIT <br />BUILUING DEPARTMENT TO BE COMPLETED IN INK - PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILDING �MECHANICAL <br />�MyAIL FD�AE$$ n I I i/� /j�� %J� <br />NER`�,D� ' Y 1 �( { r(.1.� �r�� �L `-1�� R�� L��C-i' L.l�� l��-i <br />��� <br />everetl <br />� <br />❑ PLUMBING <br />❑ SIGN <br />� Cirv ZI rnurv� - <br />nq HiTELlOP0E51GNEN MailAD0��E55 <br />1�+.' <br />fiLNEiALCONiRAC10f1 MnLLP00RC55 C�tl' LIP VpONE LICENSE• <br />I;r, <br />]USS OF WONN <br />❑ NEW ❑ AD�ITION <br />lAlllAilON OF WORKICOSi OF M� <br />�oi <br />WOPN <br />L_ <br />�ODFE55 <br />i n / <br />LiP <br />h1All. <br />uCEN5E � <br />� <br />ALTERATION ❑ aEPAIR ❑ DEMOLIIION ❑ WOODSTOVE/FFPLINSER7 ❑ BUILDING RELOCATION <br />PLUM8ING - iJ <br />NO. TYPE OF FIICTURE OR <br />WATER CLOSET �TOILETI <br />BATHTUO <br />LAVATORY�WASHBASIN� <br />SHOWER <br />KITCHEN SINK d DISP. <br />DISHWASNER <br />L4UNDFYTRAY <br />CLOTHES WASHER <br />UHINAI <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS - RAINLEA�ERS <br />SINK (SERVICE - OAR. ETC.� <br />SUBTOTAI <br />— PERMIT <br />— TOT/ I�EE <br />rRCFi5E18ACh HE>A SEiBALK <br />��s� ruNt �or nnEa <br />fVVIIOfCONSi OCLUPANCYGR< <br />;i2E OF B�DG rv0 OF STOPiES <br />fIFE SPRINKLERS f7EOl11RED ❑ YES <br />al'i'l,l;T110NACC OY IPLCNS <br />FOUR <br />�f <br />SIOE SCLBACI <br />vncurt srt� <br />OVES O��O <br />�p l�pOFDWEL <br />MAa �CL iC <br />7 NO <br />ev arcn �oAis <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCeS GOVERNING TH IS TYP[ <br />OF WORK WILL BE COMPLETED WITH 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 />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE Of LONiRACTOR OA AUiHORIZED AGENT OATE <br />X ��n�n�� 1<�c � �3�'S�( <br />4r�uCa+rS irrBu5ME55LickNS[�+0 <br />MECHANICAL <br />NO. TVPE OF EOUIPMENT <br />q/C - A/MNDIG UNITS - M P <br />REfRIGERATION UNITS - MP. EA. <br />BDILERS - B.T U /N P. <br />GAS FIRED A.C. UNITS - B.TL. <br />FORCED AIR SVSTEMS - B T Ll. M EA. <br />� WALLHEATEFS-BSL. �� M <br />UNITHEATERS-O.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHESDRYEFS <br />VENTILATION FAN <br />RnNGEHOOD <br />L WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPIACEINSERT <br />MEAT Pl1MP <br />_ GAS PIPING <br />E%HPUSTFAN <br />S118 TOTAL <br />PERMIT <br />TOTALFEE <br />VLaN CHECKNUMbEN IFEE <br />RECEIPT NO. <br />FEES VALUATION rci � <br />�-�— <br />BUILOING g <br />—�' <br />PLUMBIIJG <br />MECMANICAL <br />OTHER � <br />STATE BUILDING SURCHARGE <br />�� <br />STATEENERGVSUPCHt.FGE <br />PUBLIC WORKS <br />TOTAL <br />PpOPER Y L�INE LOGATIONS ANDNFiEBATED EASEMENTISING ALL <br />J, _ <br />i�_, ' <br />t:/ . <br />i:��. <br />� ;''1 <br />'r. <br />?': <br />ti,; l <br />`. .. <br />( ,!, <br />l'� <br />k? ' <br />i: ti' <br />. i� <br />L: <br />ri �: <br />!''?'. <br />F <br />�.'.. <br />