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';.PPLICATION FOL <br />IRS CONEe <br />O,°"" CONSTRUCTION <br />cm or <br />everett PERMIT <br />BUILDING DEPARTMENT 259•8810 TO BE COMPLEI: LT :N INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING KMECHANICAL ❑ PLUMBING G SIGN <br />1_,E.ICl14L <br />LtJG <br />!t/Y/f/AIE //1rLlW E <br />/P�LI <br />LUMira✓ <br />ARLNIlCC10R OkYONfR <br />44LfWRf BS <br />rI.oNE <br />CAREFUL CON' RACIOR <br />MAIL ADDRESS <br />CITY <br />bP <br />"'ONE <br />LICENSE <br />R <br />MECHANICAL CONTACTOR <br />MAIL ADDRESS <br />CCITYEIR <br />PHONE <br />LICENSE I, <br />EIAEITERCEo st7IiE Siu• <br />9'Ill yAVE'l> <br />6,-ew r <br />`%AZO/ <br />7;Z 3//4 EY•EQ-L•S' <br />S3 D2D@ <br />PLYMBINOCOHIPAC'OR <br />4MLAp0"13S <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />® NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLMON ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUADON OF WORK ICOSI OF MATERIALS FILMS LABORI <br />OESCRBL WORn PS / p L <br />A <br />YSE 01 BUILONG <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />!ASLT_ �p <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />ua+L DEscRlPvox PRovERrn]HowN euow aR ArucLl DUR CDR SI <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT_BLOCN` <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />I <br />X <br />PLIUN FSCRY BONNE 53 LICE NSE NO <br />I/IA/p)j ADDRESS <br />,^ <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />AIC — A.HNOIG UNITS — H P <br />REFRIGERATION UNITS — HP EA <br />BATHTUB <br />LAVATCRY (WASH BANNI <br />BOILERS — B T U IH P <br />GASFIPEDAC UNITS —BTU <br />SHOWER <br />iCPCED AIR SYSTEMS —BTU MEA <br />KITCHEN SINK p pISP <br />WALL HEATERS —BTU M <br />DISHWASHER <br />C <br />LAUNDRY TRAY <br />UNIT HEATERS —0TU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VCNTILATION FAN <br />FLOOR DRAW <br />RANGE HOOD <br />BPC KFLOW PREVENTERS <br />-Al ERIIEATER <br />ROOF DRAINS — RAINLEAOERS <br />WOOD STOVE <br />SINK ISERVICE —BAR ETC I <br />METAL FIREPLACE p CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EKHAUSTFAN <br />SUBTOTAL <br />f <br />sue TOTAL <br />PERYIT <br />C� <br />) <br />PERMIT <br />f <br />TOTAL FEE <br />S <br />TOTAL RE <br />PLAN CHECK NUMBER <br />RECEIPT NO <br />REAR 6EEBACnN <br />I I•J4t ]f1eACK <br />I1FE <br />r'.I ONE <br />LOTAREA <br />LUATION <br />FEE <br />n PFOICONST <br />OCCUPANCYOReS]QE <br />=SURCHARGE <br />OF BLDD <br />NO OF MORRIS <br />t_Atf <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />-.. ,:•ipY ALL BY <br />PLANS C.ECAEOBY <br />APPR FOR ISSUANCE By <br />PUBLIC WGF ES <br />TOTAL <br />Ia1 F FOR OFTFRMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />