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r��PLICATION FO�:��' <br />�'E"'°'"" CONSTRUCTION <br />pT OF <br />everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK • PLEASE PRINT <br />259•8810 <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL <br />OWN^[n p Mn�l �non6s citt 7�r <br />/—L�C�IL� /) 7[ L ��.�CY ) �i��/� U�%i�a^l<_ ,�C? /t.(�. ��L{ . lt�i._) `1�YriC <br />.......,,.�.�, �n r�� <br />❑ PLUMBING <br />❑ SIGN <br />� GENER�I GONIR�GIOP M�IL AOp�E55 C�n' Zlv CIIOH[ UCENSC � <br />' M[CN�HiGt CONIF�C100 MML �ODRESS ��ry Zi� PHONE IICENSE • <br />N� 7cc� -�-;-�ac�N(n <br />� %UMlINOCONfR�CfOR MAII ApDPc55 4�rr � nr PIIONE UCEMSE • <br />' j�JA71.(2AL i��� ,LZaI)I(� CC1) l�oi�J � 171CI.C��tP11ZCic) �/� IZIL i��Sg����/ <br />��.SS �F WORK <br />❑ NEW ❑ �DDITION ❑ ��tERATtON ❑ REPAIII ❑ DEMOLITION ❑ WOOOSTOVE/FRPI.IN:�EPT ❑ BUILDIN6 RELOCATION <br />w�u�uoN or woaK �cos+ or Metenieis rws ueon� <br />i <br />DE`CHiBEwOnn �I <br />` � � ,� <br />•� USE OF BU�lDIH6 <br />; l21 <br />� lEO�IDE�GRIPfIONO� <br />• �or—aioc� <br />M.UMISING <br />Np, TYPE Of FlIITURE ON I' <br />WIITER CIOSET ITOILETI <br />911MTUB <br />LAVIITOAY (W�SM B�SINI <br />SHOWER <br />NITCMEN SINK 6 DISP. <br />DISNW�SMER <br />UUNDRY iR�Y <br />CIOTMES WASNER <br />URINAL <br />OPINNINQ FOUNTAIN <br />FLOOR DRAIN ' <br />BACKFLOW PRE�ENTERS <br />ROOF DR�INS — Rp�NIEADERS <br />SIKK �SERVICE — B�R. EiCJ <br />Slis TOTIIL <br />f 512EOFBlOO <br />S <br />� FIRE SPRINKL' <br />' �PPULAl10NPCC <br />� C�,��fe2, .-hfC�f �c-v <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMI�ED THIS AP• <br />PLICATION AND KNOW TNE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINAIJCESGOVEFNINGTHISTVPE <br />OF WORK WILL AE COMPIETED WITH WNETNER SPECIFIED HERE- <br />IN OR NOT. THE GRANTINCa OF A PERMIT DOES NOT PRESUME TO <br />G�VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNAIUBE Of CONiRnCiOR OR AUiNO�IZED �GENT DAiE <br />X A( d� �/1 / A, . ri - rI —Q'� <br />NO <br />MECHANICAL <br />�E NO. TYP£ OP EOUIPI <br />NC — �/MNDLO UNITS — M.P. <br />REFFIGERATION UNITS — H P. I <br />BOILEPS — B.T.U.//I.P. <br />OAS FIRED A.C. UNITS —B.T.U. <br />� FORCED AIR SYSTEM9 — B.T.0 <br />W qLL HEATERS — B.T.U. <br />UNIi HEATERS — U.T.U. <br />LOinNe� . y�C�NiS�IE <br />OY@5 ONO <br />OCCUP�NGYGROUP NO.OFpWELLIN0UN175 <br />NO OF SiORlE3 M�N.00L LOAO <br />BV <br />BV <br />VENTtLATION FAN <br />RANOEHOOD <br />WATERHEATER ., <br />WOODSTOVE <br />METAL FIREPUCE d CHIMNEY <br />FIREPUCE INSERT <br />HEATPUMP <br />OPS PIPING <br />TOTAL <br />I TOTALFEE <br />PLnNCMECK NUMBER IFEE <br />OUILDING S <br />PLUMBING <br />MECHANICAL <br />OiHER <br />$TATE OUILDING SUACHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAI <br />M EA. <br />M <br />M <br />RECEIPT NO. <br />PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMININO ALL <br />PROPERTV LINE LOCATIONS AND RELATED EASEMENiS. <br />