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In. Ew,p,»n <br />wn or <br />everett <br />BUILDING DEPAFi?MENT <br />259•8810 <br />,.PPLICATION FO.. <br />CONSTRUCTIQN <br />PERMIT r <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />r�eretl <br />� <br />O DEMC�LITION ❑ COMBINATtON ❑ BUILDING !7 MECHANICAL O PLUMBING ❑ SIGN <br />ow�n. u•,i eoowtss citt zm m�oH� <br />!�,Po r� ,r�� � ��=,�1 ; cv y•i1i� ir/..J,vo ni? L v�it<-'lT Y�;t o'3 3:;'s__3 /��Y <br />u�aaienueu�siuHcu u.n.woNess u zin r��om <br />ri �n.rui c nrnn�uon u�n.nuness orv nn nuan. ucuis�.. <br />C>�'��'+�'- - -- <br />r+trn.wrucor�vur.�oq Me!ieooa[ss cnv rm runvt Licn+sr. <br />eoonrss <br />PHpN[ I I1U15! • <br />CLess or wonr <br />❑ NEW ❑ �DDITION ❑ ALTEPATION ❑ AEPAIR ❑ DCfAOLfiION � WOODS70VE/FRPL.INSERT ❑ BU�I�ING F7ELOCAiION_ <br />v+�u+��or� ur won..,cos� or e�..i in�nts �ius «non� <br />✓ <br />us[ <br />or OnpnERiv i5��owN o[ Ww oi1 <br />PLUMBING <br />NO. TYPE OF FI%TU <br />W�TER CLOSET �TOILET) <br />8�1HTUB <br />U�ATORY �WASIi BAS�NI <br />SNOwER <br />NITC�iEN SINK 8 DISP <br />LAUNDRV <br />URINAI <br />DRINKING FOUNTAIN <br />FIOOR ORA�N <br />BACKFLOW PREVENTE�75 <br />ROOF ORAINS — PAINLEADE <br />$INK �SERVICE — OAa. ETC 1 <br />u�� <br />��n� or c0��S1 <br />OR <br />SUB TOTAL S <br />VERMIT f <br />TOTAI FEE f <br />I HER[DY' CFRTIfY 711Ai 1 HAVE READ AND EXAMINED TIIIS �1R <br />PLICATION AND KNOW THE SAME TO BE TRUf_ ANDCORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCESG6VERNING 7H15 TYPE <br />OF WORK WILL BE COMFI.E7ED WITH WfiETHEF SPECIFIED HERE� <br />IN OR NOT. TIiE GRANTING OF A PERAIIT DOES NOT PR[SUME TO <br />GIVE AUTHORITY TO VIOLAIf �.7 CANCEL TH[ PROb'SIONS OF <br />ANY OTHER STAtE OFl LOCAI �. �.'.Y REGULAT�NG CONSTRUCTION <br />OR THE PERFORMANCi OF CONSTRUCTION. <br />$IGNAIUIIEOfCONIHACIOAOR�UIHORIZF.D•'CiCNf pni[ <br />X <br />55 <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPME <br />A�C — AiHHDLG UNITS — H P <br />REFRIGERATIO��UNITS—NP EA. <br />OOILEPS — B.T.0 /N P <br />G4S FIREO A C, UNITS — BS.0 <br />FOFCE� AIR $VSTEMS — B TL. <br />WA�� HEAiERS — O.T.0 <br />UNIT HEA7ER5 — 0 T.0 <br />EVAPOR�TIVECOOIERS <br />CLOTNES DfivEPS <br />VENTILAiION FAN <br />RANGEHOOD <br />WATEfI MEATER <br />WOODSTOVE <br />METAL FlREPLACE 6 CHIh1NEV <br />FIRE7LACEINSERT <br />NEALPUMP <br />GA$ PIPING <br />E%HAUSTFAN <br />SE�OAGN 5�0[ SEIB�CN I�'lAN CIiECK NUMBER <br />pr S10uiE5 <br />BY <br />VACRIi $IfE FEES <br />❑rEs tv+o <br />.,I' OING <br />ND Of pWfILINGUNIiS <br />er <br />PLUMBING <br />MECNANICAL <br />SUB TOTAL <br />PCRMIT <br />70T�LFEE <br />IFEE <br />M EA. <br />M <br />M <br />ree <br />RECEIPT u0 <br />VALUATION � <br />5 <br />OTIIER <br />StATE DUILDING �.URCHARG[ <br />S7ATEENERG`SURCHARGE <br />PUBUC WOR'•S <br />TOTAL � <br />PfiOPERTY OWNERS �RE RESPONSIBLE fOR DETERMINING ALL <br />PROPERN LINE IOCATIONS AND PEL�IED EASEMENTS. <br />0 <br />