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, . . . ,,._ ,. .. , .. . . . . . .. .... . . .. .__.__._ .. . . ,...,�..�.�.. <br />�,-.PPLICATION FO�� <br />'"'E"�"'" CONSTRUCTION <br />�,n � <br />everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK- FLEASE PRINT <br />259-8810 <br />❑ DEM7LITION ❑ COMBINATION �BUILDING ❑ MECHANICAL <br />I� <br />M11L <br />evereM <br />e <br />❑ PLUMBING ❑ SIGN <br />vHor�e <br />� 3SS-SdD/ <br />JC � ��TM IIP VMONE LICENSE • <br />GENEP�IGONTR�CTOR M�IL��ORE55 <br />MELH�NIC�LCOT��Oq MMLAODAE55 GiTY ZIP PMONE IIGENSE• <br />PWMB�N6CONTRALTOR M�ILAOORE55 bTv 21P P��ONE UCENSE• <br />CUSS OF WOAK <br />❑ NEW ❑ A�OITION I� 4lTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />yµp�TiON OF WORN ICOST Of MATERUL� o�US 1�60Ri <br />jt��VQV` �i <br />DESCRtBE WORN <br />�m— <br />� `�{!� G � P� <br />FROIEGi.1DDpESS <br />�� � �i Et.S i � <br />PLUMltNG <br />NO. TY�E OF Fl%TURE OR 17 <br />. WATER CLOSET ITOIIET� <br />BATHTUO <br />� UIVATORY IWASM BASINI <br />SHOwER <br />� KITCHEH SIN� i DISP. <br />� pISHWASMEN <br />LAUNDRYTRAV <br />CLOTHES N/ASHER <br />UPIN�L <br />DRINKING FOUNTAIN <br />FLOOR DRI11N <br />BACKFLOW PREVENTERS <br />HOOF DRAINS — R�INLEADERS <br />S�NN ISERVICE — BAR. ETC.� <br />five ✓'oov.�� . <br />COVIE51 <br />fEE <br />8USTOTAL • <br />PEPMIT � <br />� TOTAL FEE f <br />IRONTSEiBACM RE�A SETB�CN SIDE SETB�CN <br />2 � s�` � �� � <br />USE20NE LOTARE� y�p�NTSrtE <br />�-Z 73so o.ESRNo <br />TVPEOFCON51� �/ OCCUPeNCYGROUP NOOFDWEL� <br />�� R-3 <br />Si2E OF lD6 NO Oi STORICS M�% OCC IOAI <br />SL � NA <br />F�RE SPRINK�ERS REOUIREO O VES �NO <br />♦CC Bv PUNSCIIECNEO BY v^ """"••"• <br />� � <br />ev <br />I HEREBY CERTIFY THAT I MAVE NtAo nrvu txnmintu in�a nr• <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED NERE• <br />IN OR NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN�TURE Of CONiRACTOR OR AUTMORI2ED AGENi D/.TE ?l�tZlo� (4�� <br />X ,.�f,.1_�CYA•�'`�? <br />MECHANICAL <br />A/G — �/HNOL6 UNITS — M P. <br />REFRIGERATION UNITS — H P. EA. <br />BOILERS — B.T.U./H P. <br />QAS FIRED A C. UNITS — B T.U. <br />FOPCED AIR SVSTEMS — B T.U. M EA. <br />WALLMEATERS—B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVECOOlEPS <br />CLOTMESORYERS <br />VENTIlAT10N FAN <br />RANGEMOOD <br />WATER HEATER <br />WOOOSTOVE <br />METAL FIREPLACE 6 CMIMNEY <br />FIREPLACEINSERT <br />MEAT PUMP <br />6AS PIPING <br />E%MPUSTFAN <br />fUSTOTAL <br />p[11 W T <br />�— TO�AI FEE q _ <br />p���ECKNUMBER�q�j�.l' FEE �� CJa RECEIPTNO. <br />�.�1— ���� � 6� 45 <br />1 7 "�--�� c <br />BUILDING SS � <br />PLUMBING <br />MECNANICAL <br />OTHER <br />STATE BUILDING SURCMARGE <br />STATEENERGYSURCMARGE _ <br />PUBLIC WORKS <br />TOTAL � <br />PROPERTY�LINELOCATIONSANDNHEBATEDE SEMENT'gIN6ALl <br />�� <br />S�Sd <br />