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�T.PPLICATION FO�� ' ���,�„ <br /> '"°E"'°'"" CONSTRUCTION 0 <br /> an or <br /> everett PERMIT <br /> BUILDINO DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑COMBINATION ❑ BUILDIN6 O MECHANICAL ❑ FlUM81NG ❑ SIGN <br /> Q�yryEp M�IL�DDRE99 GIY SIp PMUNE <br /> ?�(,Q .� ��ao,.� z32� Tc:�L�:.�.� E��Y- 9d�v� ��4-7lyS <br /> ♦R�NIfECTOAU NEA MM��DORESS CIT' lIV VHONC <br /> ,� � 7` 63a5 SR4� :�d -.�,•a�.r- 9��s� 33v ��i � .9J.�,y,a�aalD�v <br /> CF EP CONfR�CIOA M�II�DORESS C��Y IIP �uONE UCENSE• <br /> MfCN�NIGL CONiN�LiOf� M�IL��ORE55 C�tV ZIP PIIONE IICENSE• <br /> OWMBINOCOH�RILIOM MAIL�DDRE55 CITY 21P PIIONE UClNSE• <br /> GL�SSOf WORv. <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION �I REPAIR ❑ DEMOLIiION ❑ WOODSTJVE/FRF�.INSERT ❑ BUILDING RELOCATION <br /> W l W�ION O�WOA✓ICOS�O�M�IC R11L5�LU9 UBOAI <br /> 3 D�D �" <br /> DFSCRiBE WOAK <br /> _ � - � <br /> use or au n+a I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP• <br /> S�2 PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> �ca� �FSCA�PT�ONO��pOPEPlY19NOWNBEIOWOR�ITICNFOURCOP1E51 pROVISIONSOFLAWSANDORDINANCE300VEPNINOTHISTVPE <br /> yq� OF WORK WIIL BE COMPLETED WITH WNETHER SPECIFIED HERE• <br /> io�JL_eiocr.�.l2'os IN OR NO f.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REOULATIN6 CONSTRUC710N <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIGN�TURE Of CONTR�CTOR OR AUiHORIZED�CENT n�te�0 -2,2- 87 <br /> X <br /> •�OJlCT��ORt!! �PFLIG�NT1 GTV OUl�NE!!LiCtNOE NO <br /> � �/ <br /> PLUMSINO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM PEE NO. TYPE OF EOUIPMEMT FEE _ <br /> W�TER CLOSET(TOILET� AiC—MHNDLO UNITS—H P. <br /> BATHTUB REFAI�ER�TION UNITS—N.P.EA. <br /> UVATONY 1 WASN DASINI BOILEFS—B.T.U./M.P. <br /> SMOWEP OAS FIRED A.C.UNIT3—B T.U. <br /> KITCHEN SINK 6 OISP. FORCED AIR 3YSTEMS—B.T.U. M�FA. <br /> O�SHW�SHER WALLHEAiER3—B.T.U. M <br /> IAVNDRY TRI1Y UNIT HEATERS—B.T.U. M <br /> LLOTHESW�SHEA EVAPORATIVECOOLEPS � i <br /> UAINAL CLOTHESDRVEPS <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR ORAIN RANOE HOOD <br /> BACKFLON�PREVENTERS W�TEA HEATER <br /> ROOF DRAINS—RRINLEAOERS 'NOOD STOVE <br /> SINK�SERVICE—BAR:ETC.� METAL FIREPLACE d CHIMNEY <br /> FIREPIACE INSERT I <br /> HEl1T PUMP j <br /> GAS PIPIN� <br /> EXHAUSTFAN <br /> SU!TOTAI f SUS�OT�L <br /> PERMIT t �p�T <br /> �OTALFEE f TOTALFEf <br /> �AUHi 5Ei0�f.k RE�n SEi9�CM S�DE SEIB�CK 7lAN CHECK NUMBER FEE RECEIPT NO. <br /> use tome �ot�nEe yAGNf SRE fEES VALUA C!C�N FEE _ <br /> OYES ONO 5 <br /> BUI�OING <br /> «��EO�CONSi OGCUP�NC�GRUOP HOAFOWEllIN6UN1iS <br /> • FLUMBING <br /> SKE O�BlDO HO Uf SLORIES M�K OCC LO�D <br /> MECHANICAL <br /> OTHER <br /> FIRE SPRINKLEF75 REOUIRED ❑VES iJ NO STATE BUILDING SURCHAPGE <br /> STATEENERGYSURCHARGE <br /> a��r�i�tnDN«CB� �LANSCNECNEDBY APFR (ORISSWNCEBY <br /> Pl1B�IC WORHB <br /> TOTAL � <br /> ii <br /> PROPERTY OWNERS ARE RESPONSIBLE FOP OETERMININO ALl ` <br /> PROPERTY LINE LOCATIONS AND RELATE�EASEMENiS. � <br /> 1 <br />