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m. e.+rpr+�n <br />Gtt oF <br />everett <br />BUILDINu DEPARTMENT <br />259•BB10 <br />'�PPLICATION FO.� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION D COMBINATION ❑ BUILOING �MECHANICAL <br />everen <br />e <br />❑ PLUMBING ❑ SIGN <br />u4l �DDNl55 d�V IIP P��ONE <br />LFTC�c.(iC�-I�-AL( ��/5 'RJCdCt:�-�CL-LL:�_� L—..1/T �I£".�J/ ,��- %�/� <br />M�IL <br />GENEflAL CONTRAC�OR M�II �[1�fiE55 G��� IiP PI�ONE LICENSE • <br />Cr�2 <br />:USS O� WORR <br />❑ NEW ❑ ADDITION <br />���t.�/- �•7 <br />M�II <br />1�� �),(�L/�if�7/�'�.1� Y��� ��5=54 <br />c�rv m� riror+e uceHSE. <br />ALTERA710i� ❑ REPAIP ❑ DEMOLI110N ❑ WOODSTOVElFRPLI'JSERT ❑ BUILDING RELOCATION <br />C CRIBFWOAK � �/����I( <br />�F_P/-/�c� ��f} _� %� ; <br />uSEo� WlowG /f <br />�j,� y , <br />LE6�L DESCRIPLON O� PROPEA1r15MOWN BELOW ON e1T�CN f(lU� <br />10��—BLOL�—OF <br />� PLUMSINO <br />� NO. TYPE OF FI1 <br />WATER ClOSET ITOIII <br />j BATNTUB <br />� UVATOPY IW�SM B�: <br />� SN�N'ER <br />I(ITCNEN S�NK 6 OISP. <br />I �ISMWASHER <br />� UUNDRY TRAV <br />! <br />� C�OMES WASMER <br />UNtNAL <br />, DRINKING FOUNTAIM <br />+ FIQORDAAIV <br />r <br />� BACKFIOW IMiEVENTI <br />ROOF DRAINS —R�IN <br />'. SINKISERVICE—B�P <br />fpOHi5Ei0�Cn <br />fYPE OL <br />� �- � vtl Ti_= �1 f�.Ctrr�=.�, <br />I HER[BY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTVPE <br />OF WORK WILL BE COMPLETED V/ITH WHETHER SPECIFIEO HERE- <br />IN OR NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHOHITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />$!GNATURE F CONtRACTOF OR AUiHO IZED AGENi �RTE <br />x ����.�/ll. ��>- ��-��-� <br />��PLIf.ANi5CI1YBU51HES5ULlNSf NO <br />� J �� f <br />MECHANICAL <br />fURE ON ITEM FEE NO. TYPE OF EOUIYMENT <br />T) A/C — p�MNOLG UNITS — H P. <br />PEFfiIGERnTION UNITS —N P. EA. <br />N� BOILERS — B,T U/H P <br />GAS FIRED A C. UNITS — B.T.U. <br />FORCEO / �R SYSTEMS — B.T.U. M Fi�. <br />WALLMEATEPS—B.T.U. M <br />UNIT HEATERS — BSL. M <br />EVAPORATIVE COOLEPS <br />CLOTNESDAYERS <br />VENTILAiION fAN <br />IiAVGE NOOO <br />qs W�TER HE�TER <br />.EAOERS WOOD STOVE <br />ETCI METAL FlREPlACEB CHIMNEV <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS VIPING <br />. F%HAUSTFAN <br />SU�TOTAL = <br />PERMIT f <br />TOTAL FEE s <br />RE�R SEIO�GN 9D[ SEiBAGN <br />LOtARE� VnCR115�1[ <br />❑vE5 �NO <br />occuP�r�erenour r+oorowe�unaunus <br />NO OF S10Ri[S MAz OCC IOAp <br />7ED ❑ VES ❑ NO <br />PLANSI'l1ECItEOOY A�PA fO0155U�NCEB� <br />SUBTOTAL <br />PERMIT <br />70TALFEE <br />%,AN I;MECK NUMBER I FEE <br />FEES <br />BUILDING S <br />PLUMB�NG <br />MECHANICAL <br />OfHER <br />STAT[ OUILOING SURCHARGE <br />STATEENERGYSURCMARGE <br />PUBLIC WORKS <br />(OTAL <br />PEGEIPT NO. <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERN LINE LOCATIONS AND RELA'iED EASEMENTS. <br />