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f_., _ --� <br /> . � � a <br /> APPLICATION FOR CONSTRUCTIVN PERMIT c�'"c" <br /> , f ,, ,, , TO BE COMPLETED IN INK—PLEASE PRINT /,,�� ' � � <br /> GiY OF <br /> everett HEATINGSYSTEM: fJGAS `,�ELECTRIC U <br /> � BUILDING DEPARTMENT ' <br /> 259-8810 <br /> DEMOLITION COMBINAT�ON BUILDING MECHANICAL PLU�dBING SIGN ' <br /> ��P�S[�ici���55 � q3� `�C�rnv�c9 Z�P �iBao' PNCNE�Sa-d5�-8 <br /> tENnNi Mn�UDDNE55 CIiY Z�P PHONE <br /> �p�1�iL1C�TOPOE'�h��R� �� `�`•WnC�(J IIP r7�7 �s-lo�-38 � <br /> ;�� 1 <br /> /f^�(\NEH�IGONtR�/�LTOR M�itpUpRE55 CI1V 2iP PHONE LI�ENSE� <br /> �� '+� 1,1[Lq���MCpNLP�CiC� MMLeDDRE55 CitV L� �MONC UCENSE• <br /> L� �Q PWMBiNGCONTR�CTO M4RAppaE55 'l$�j ��t� ZiP VHONE ULENSE• <br /> �i0 h��urns �ns'�r�c}%o� ��c0.rti J�mi+h"�"`� E�efek� �l `b201 �58-LUn4 kloopQC..�-�33.�"L <br /> � �� ClA$$OF WOPI( <br /> � NEW ADDITION --�C.ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br /> ��� �i5 r,uv i s � '� r.�r���"n���tlEN��r�u,�� a5q� a3o3 <br /> � CONiRe�TpqILF.OP1 !iN /� ('�� <br /> �7 OESCP�O[WORK A SO,. [F(�Q G[IHt�IVED , �, n �11 I (���1/C`��S �� �� �1 .y��-� <br /> �� Chanqe. un��;,�,e9, ase��,lr -+,, a Ixd�,,, � ca�- � � ' F_ J « Y-� � .� <br /> aaoaosenuseoi-euuowc I NERE�Y CERTIFV THAT I HAVE READ AND ExAMINED THIS <br /> 0 � Du . 1� APPLICATION AND KNOW THE SAME TO BE TqUE AND CORRECT.ALL <br /> � � �[m�oescaivrarvo�rnorean�sHewr�eci.owoa�necNwuecowesi PROVISIONSOFIAWSANDORDIN4NCESGOVERNINGTHISTYPEOF <br /> �• i � WORK WILL BE COMFLETED WITN WHETHER SPECIFIEO HEREIN OR <br /> �„� io�; y�3"� _ aiocn _3^I a oF L�I � NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> r M E��,�� ��J�S�un G ` � AUTHORI7V 70 VIOLATE OR CANCEL THE PFOVISIONS CP ANY <br /> VO H 0. � �I� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � ` / � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ��� I�eCGfdS U� Sf�Onvw`�5� l.�U�^w'� _ (,U OWNEP OF THIS PHOPERTV TO PERFORh7 THE WORK FOP. WHICH <br /> APPLICATION IS MADE AND I COMP�V WITH THE STATE <br /> CONTRACTORS LAW 1827 iiCW AND 296.2001vA4 <br /> �� �� TAx c� ti 3�y — 3� a — U3� = 5���� REOfCONiR�CTOROp/�/iHORIZEORGEN. DSiL <br /> �� —'_ _ — l�-i <br /> ' �� v�3 �GL""�1 pzt,r�� <br /> � anaecr�oonEss -- <br /> I^ �U l"fQ�� � Q! \� I . ` p AP CAMSGrtVBU51NE55lIG[NSENOANDBUSiNE55NAM[ <br /> �'� �d � W IT <br /> • . PLUMBING MECMJINICAL <br /> I NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � �� � y� WATER CLOSET(TOILET) A-C—lvHN�LG UNIiS—H.P. _ <br /> 1 VC BATHTUB W�Ta rjlk0 E1L yi� FORCED AIH SYSTEMS—B.T.U. M E.A. <br /> j LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M _� <br /> SNOWER /'X CLOTHES DRYERS <br /> KITCNEN SINK 8 DISP / VENTILATION FAN � <br /> I __ / X DISHWASHER c�'-- RANGEHOOD �— <br /> �, LAUNDRV TRAY � WATER HEATER _ � <br /> i x CLOTHES WASHER WOODSTOVE _ '��CD� <br /> _ URINAL METAL FIREPLACE&CHIMNEY ' <br /> ORINKING FOUNTAIN FIREPLACE INSERT �_ <br /> �I 1� FLOOR DRAW HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOFDRAINS—RAINLEADERS E%HAUSTFAN <br /> �'= SINK(SERVICE—BAR,ETC.) _ <br /> n <br /> �t�� SUB TOTAL 5 _��_IC� SUB TOTAL $ L(^ ��_ <br /> . PERMIT $ PERMIT S <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: < � . <br /> fNONTSETU�CK REAFS[iBRCK SiDE5Ci0ACH PLANCHECNN MB[N FE[ G �(i P[CEInTNO <br /> � ' � ' � /OS3 <br /> usero ^� �orneen VACANTSITE F S VALUATION FEE <br /> �' .J N� DUILDING 'j i $'Z� <br /> ttPfO�CONiSRILOWRBIF IYF[OiCO51ACi �l xeueevtv NOqvnYu�1.u�n5 i <br /> �_pj°.; PLUMBING �_�' [n <br /> SIZ[OF BLOG NO OF STOqiES BASEMENi MECHANICAI ` '�"� <br /> g 56 5.G REbv�. 5 ✓ ryp <br /> (ri,f.UPPNCYLOAO ilR[SPRNKLER511EOD MEIGHTUMITATION ADDITIONALPLANCHECK ^ ��-/ � aO <br /> I <br /> N� OTHEF <br /> R[ASON FOR SPRMKLER$ —�— <br /> STATE BUILDING SURCHARGE �15� <br /> INTANE BY PLANS APPROVlD�V ��iy 0F EVEREIT PUBLIC WORKS L,U i L{/ <br /> LOCAL SALES ' <br /> TAX COOEIS 3105 Torn� � <br />