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� � . .:� � r PLICATION FOh-� <br />; ,".`"'°'"" CONSTRl.JCTION <br />� CIT' OF <br />�� everett PERMIT <br />BUILDINO DEPARTMENT <br />269•8810 TO BE COMPLETED IN INK• PLEASE PRINT <br />O DEMOLITION ❑ CQML;INATION ❑ BUILDING ❑ MECHANICAL <br />w'"� p M�ILADORE55 G�1Y Zi� <br />j"UCICE7T, ��ss 5a2 o iNr�� T�L�Ug /11iAC�'Shctte.' 1 <br />A CIIIIECIOROF9�ONF M�II�UDf1E99 CIIY Z�P <br />%�li�,�/Q�C '� �a�o�e /�/_. f�Sir ,Fit�x'f�� �'�.�o/. <br />OENEP�ICONfH�G10R MMI�ODf1E53 �i�Y Z�P <br />�ss %uc�f S�2o ��'=''` �•,vE- a�vys. ��. <br />[.1_.......... ., e n... MMI�ODRE�! 9 Gliv� P <br />CL�310! WORIt <br />�� ❑ NEW ❑ ADDITION ❑ AL <br />0 <br />� � <br />I�EM <br />WATEPCLOSET�TOILETI <br />BATNTUB <br />UVATORY �WASH B�SIN� <br />SNOWER <br />KITCHEN SINN ! OISP <br />DISHW115HER <br />UUNOHY TRAV <br />GLOTHES WASHEP <br />URINAL <br />� DR/11N5 — R�INlEA0ER5 <br />ISERVICE — BAA. ETC 1 <br />�AONfSEIB�C1t � <br />� <br />USE 20N <br />�� <br />n'�EO� ONSI <br />-�v <br />SRE Of B100 <br />96 � s� <br />SUlTOTAL <br />PERMIT <br />Zo• <br />•Oe.E��� � <br />V� � <br />IUMNGY GBOUP <br />R-3 <br />Of S�O�IES <br />v <br />�vnuc�non�ec er ni�r�scnecneoe <br />/� <br />� 5�5 � t a1 � <br />c�r�u�L1- ar�. <br />���,�n <br />� <br />❑ PLUMBING � � SI(3N <br />PNONE <br />� 6s ,3- //oy• <br />P�IOHE � <br />25a-�97( . <br />�I�ONE LICENSE • <br />G'S3 -//� <br />P110NE LICEN4E • <br />Vi�OME LICENSE • <br />� REPAIR ❑ DEMOLITION ❑ WOGDSTOVE/FRPL.INSERT Y� BUILDINO RELOC�TION <br />I HEREBY CERTIFY <br />PLICATIONANDKNi <br />�r'Es� pROVISIONSOFLA' <br />�1�V OFWORKWILLBEC <br />'' IN OR NOT. THE GR� <br />� OIVE AUTHORITY T <br />� ANYOTHERSTATEI <br />OR THE P�RFORMI <br />HAVE READ AND EXAMINED TliIS AP• <br />SAME TO BE TRUEANDCONRECT. ALL <br />ORDINANCES GOVERNING THIS TYPE <br />�,TED WITH WHETHERSPEGFIED HERE <br />OFAPERMITDOESN7TPRESUMETO <br />1TE OR CANCEL THE PROVISIONS OF <br />AL LAW REGULATINCa CONSTRUCTION <br />F CONSTRUCTION. . <br />UiHO�IZEOAGENT O�7E <br />INESS ItCENBE HO <br />FEE NO. TYPE OF E�UIPMENT <br />AiC — A/MNDLO UNITS — H P. <br />FEFRIGERATION UNITS — H P. E11. <br />BOILERS — B.T.U./HP. <br />GAS F!RED A.C. UNITS — B.T.U. <br />FOACED AIA SYSTEMS — B.T U. M EA. <br />WALLN°ATERS—B.T.U. M <br />UNITHEATERS—B.T.U, M <br />EVAPORFTIVE COOLERS <br />CLOTHES DRYE(i5 <br />VENiILATION FAN <br />RANGEHOOD <br />WATERHEATEN <br />WOODSTOVE <br />METAL FIREPLACE A CMIMNEV <br />FIREPLACEINSERi <br />HEATPUMP <br />6AS PIPIN6 <br />E%HAUSTFAN <br />Si�E <br />SUe TOTAL <br />P[RAMT <br />TOTAL F!E f <br />PLnN CMECK NUMBEN FEE PECEIPT NO. <br />��rl�o��R cFii� 10(�39 <br />V�C�N SIIE <br />OYES O <br />NO OF DWFLLIN <br />� <br />Me[ OGC LOn�D <br />/�? <br />mn issueN <br />!� <br />Ur C. Fe� <br />�� <br />BUILDING <br />PLUMBING <br />MECHANICAI <br />OTHER <br />STATE BUILDIN6 SURCHARGE <br />STAiEENERGYSURCNARGE <br />PUBLIC WOfiNS � <br />TOTAL <br />PROPERTY OV�NFRS ARE RESAONSIBLE FOR OETERMININO ALL <br />PROPERTY LI� E lOCA710N5 AND PELATED EASEMENTS. <br />