Laserfiche WebLink
fM EraprNn . <br />e�Tr or <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />,... <br />'�-�`�,�PPLICATION fa`:: <br />COfdSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />O DF�viOLITION ❑ COMBINATION ❑ BUILDING ❑ ht�ECHANICAL <br />MAIL <br />.� <br />cnv <br />❑ PLUMBING ❑ SIGN <br />PnONE <br />���' ��� <br />r�w�+[ <br />vPONE 4CEMSE • <br />/�lsr.�.9s�z, <br />ruoHe LiCENSf.. <br />VLUMBINOCONfF�C�O�i �.UIL�DDRESS Cli\ ZI{• PIIONE IICEHSE• <br />CL�SS Of WOPN <br />❑ NEW ❑ ADOITION ❑ ALTERFTION REPAIR ❑ DEMOLITION ❑ WOODS70VE/FRPL.INS[RT ❑ BUILDINC RELOCATION <br />V11LU�LON Of WORN iCOSi Of M�fEA��LS P W 5 LA00�1 <br />� � �� <br />..ve�eiec wnoe �� r\ <br />rv <br />G'd <br />PLUMSiN6 <br />NO. T <br />WIITER CLi <br />BATHNB <br />UVIITORV <br />SMOWER <br />LAUNDFV <br />CLOTHES <br />URINAL <br />15NowN OELow on <br />OF FUfTURE OR ITEM <br />a <br />PREVENTEPS <br />i5 — RAIN.EAOERS <br />CE — ^ :N. ETC.1 <br />T0TJ1L FEE <br />Br <br />FEE <br />f <br />f <br />vRCANt SiIE <br />❑vE5 ONO <br />NO OF OWFI <br />MA% OLG LOAD <br />I H�REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICAT�ON AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSANO ORDINANCES GOVERNING THISTVPE <br />OF WORK WIIL BE COMPLETED W�TH 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 />ANY OTfiER STATE OR LOCAL LAW REGULATING CONSTRUCTIUN <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNAIURE O� CON79AQGR O� �I1i110l111E0 1GENT DqTE <br />X ����� � �� <br />LiCENSE NO <br />MECHANICAL <br />TYFE OF EOUIPMENT <br />A/C — A/MNOLG UNIT3 — HP. <br />REFHIGER�TION UNITS — H P. EA. <br />BOILEPS — B.T.0 /H P. <br />CAS FIRED A C. UNITS — O.T.U. <br />FORCED �IR SYSTEMS — B.T.U. <br />WAIL MEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHESDRYEPS <br />VENTILATION FAN <br />R�NGEHOOD <br />WATEHHEATER �, <br />WOODSiOVE <br />METAL FIFEPLACE 6 CMI4INEV <br />FIREPUICEINSERT <br />HEATPUMP <br />GAS PIPiNG <br />E%MAUSTFAN <br />SUBTOTAL <br />� TOT�LFEE <br />PLAN CHECK NUMBER I FEE <br />M EA. <br />M <br />M <br />FEES VALUATION <br />BUILDING 5 <br />PLUMBING <br />MECNANICAL <br />OTHER <br />STATE BUILDING SU�7CHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />RECEIPT NO. <br />PROPERTY OWNEFS ARE F7ESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONSAND RELATED EASEMENTS. <br />