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,MEw„�.� tiPPLICATION FOk <br />°�^�°° CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-A810 TO BE COMPLFTED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION �BUILpING ❑ MECHANICAL <br />pWN� � n - M41L PD�R[55 n ' CITY � ./�21P <br />AIAR <br />PIUMBIN � CONiP4Ci0R <br />❑ PLUMBING ❑ SIGN <br />PNONE <br />1.IlY aIV 1�IIIiNC <br />��CIIV 21P PUON[ <br />�lcia��3 �Sr' <br />Grv LP r�ONC <br />Cirv LP Pi�ON[ <br />Q� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE;FqPL.INSERT ❑ BUILDING RELOCATION <br />V�W4110NOfWORhIC05v��MA1[RIAlSPWSLABORI ' - <br />�Z on J <br />oesCnree wonK <br />LEGnL <br />�� � <br />PAOJECT�DORE55 <br />PIUMBING <br />NO. <br />PNOPEPTVISHOWN <br />OR ITEM <br />LAVATORY �WASH BASIN) <br />SMOWER <br />KITCMEN S�NK ! DISP. <br />DISHWASHER <br />UUNDRV TPAV <br />CLOTFIES WASMER <br />URINAL <br />ORINNING FOUNTAIN <br />�AONiSE1B�l'h <br />25� C:. � � <br />USE :ONE c <br />� i <br />5�V <br />� XXlryl <br />— BAR. <br />SUSTOTAL <br />VERMR <br />�70 � 25� <br />LOiNREN <br />3�,eoo <br />OCCUPPNCVGROUP <br />�-3 <br />_� <br />iCC BY P�ANSCHECNEDBV <br />y� ��C� <br />�OUR COPIESi <br />s�t16/-l-Um �Si� <br />� <br />f <br />f <br />Si�E SETBACN <br />�� V,a <br />VACjJli SITL <br />C�ES ONO <br />�ono <br />RPPP GON <br />� <br />e <br />�' `' i <br />W <br />I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVIS�ONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPL ETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />�VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />NYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCT!ON <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU�E OF CONiRACTGR OR NU7110RIZED AGENT ❑aTE <br />��5 <br />MECHANICAL <br />TVPE OF EOUIP <br />A/C - A/NNOLG UNITS - M �. <br />REFRIGERATION UNITS - M P. <br />OOIIERS - B.i U /N P <br />GA$ FIRED A C. UNITS - p.T.U. <br />FORCED AIR SVSTEMS - B TL <br />WALL HEATERS - BSL. <br />UNIT MEATERS - B.T.0 <br />EVAPOR� TIVE COOLEfIS <br />CLOTMESDRVERS <br />VENTILATION FAN <br />HANGEHOOD <br />WATER HEATER <br />wOOD STOVE <br />METAL FIREPLACE 8 Cl/IMNEV <br />FIREPLACEINSERT <br />MEATPUMP <br />GAS PIP�NG <br />EXMAUSTFAN <br />M EA. <br />M <br />M <br />6 -/S-'-�'% <br />SUBTOTAL <br />PEpMIT <br />TOTAIFEE �— <br />PLnN CHECK NUMBER FEE I HECEIP� <br />�c81>c�Z��i I �G�f53 <br />BUILOWG S <br />PLUMBING <br />MECHANICPL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENEPGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERN LINE LOCATIONS AND RELATED EASEMENTS. <br />