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��.Ewro,,,� �.PPLI�ATION FO1. � ���,�„ <br />��n�F CONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPAP,TMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />�i <br />❑ COMBINATION ❑ BUILDING f�MECHANICAL ❑ PLUMBING ❑ SIGN <br />M�IL�UORE55 CIIY ZIF PMONE <br />�� �tdl2 �1 u.k� 11-eo E3� vd_. -�verztl �'s'Zo� q a7—c�Q 2 q <br />PMONF <br />GkNEMLCONtN�(:100 M�IL�UORE55 C�tt SIP n1�ONL LiCFNSC. <br />M�iL 11UORE55 <br />�S 113� <br />Meii �ooness <br />cin . nr <br />21P <br />cuss or wonK <br />❑ NEW ❑ ADOITION I� ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/�RPL.INSERT ❑ BUILOING RELOCATION <br />9.wypN or wo&� lcos� or uerznuts rius �eeom <br />usr <br />ioi_ <br />I(�22 N� <br />PIUMBING <br />NO. TYPE OF FIXTUHE <br />� WATER CLOSET �TOILEi� <br />��` �' o I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED TIiIS AP� <br />� PLICATION AND KNOW THE S�ME TO BE TRUE AND CORRECT. ALL <br />Y�SHOWNBEIOWOp�iTAGNFOURGOPIES pROVI510NSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br />OF WORK WILL BE COMPLETED WITIi WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO I <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW WEGULATINGCONSTRUCTION <br />— . OR THE PERFORMANCE OF CONSTRUCTION. . <br />. $IGNI1TUpE OF CONIRRCTOR OR AUTNOR12E0 AGENi I141E <br />\ <br />C;�- !0 � �; <br />APPUC� SLttV8U5���lSSl�CE115EN0 <br />� I-�� gilva.... <br />LAVIITORY �WASH BASIN� <br />SHOwER <br />KITCMEN SINK 6 �ISP. <br />OISHWASHER <br />UUNDRV TRAV <br />CLOTNES W�SMEP <br />URINKIHG FOUNT! I <br />FLOOR DRAIN <br />BACKFLOWPiIEVEN E � <br />ROOF DPAINS — RFINLEADERS <br />SIN.. �SERVICE — BnR. EfC 1 <br />�uON15E1B�Gk <br />USEICNE <br />iC4110N ACC '.v <br />SU! TOT11L <br />PEpM1T <br />TOTAI FEE <br />St: <br />pCCUP�NGYGPOUP <br />BY <br />VRC�NI SIfE <br />OYE$ ONO <br />NO.OF OWELLING UNI7S <br />Mez. occ �o�o <br />•PPN. FOB ISSU�NCE BY <br />MECHANICAL <br />TYPE OF EOUIPMENt <br />A/C — A/HNDLG UNITS — H.P. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — D.t.0 /1/ P. <br />GAS FIREO AL. UNITS — B.T.U. <br />FOHCED AIR SYSTEMS — B.T.U. �(�M EA. <br />WALLHEATERS—B.T.U. M <br />UNIT HEATERS — B.TL M <br />EVAPORATIVE COOLERS <br />CLOTHESORVERS <br />VENTILATION FAN <br />RANGEHO00 <br />WATER HEATER <br />WOODSTOVE <br />IAETAL FIFEPLACE 6 CHIMNE� <br />FIREPIACEINSERT <br />HEATPUMP <br />OAS PIPINO <br />EXHAUSTFAN <br />SUBTOTAL <br />P[HMIT <br />TOTALFEE <br />PLAN CHECN NUMBER � FEE <br />FEES ' <br />BUILOING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURC4ARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAI <br />RECEIPT NO. <br />FEE <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMININ� ALL <br />PROPERTY LINE LOCATIONSAND RELATED EASEMENTS. <br />