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,�.Ew,,,�� %r�PLICATION f01�-� <br />��TM°F CONSTRUCTION <br />everett PERMiT <br />BUILDING �EPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION 1� COMBINATION <br />]WNEH MAII ADORE� <br />iy r1• <br />❑ BUI�DING ❑ MECHANICAL <br />ScmfHc <br />everett <br />� <br />❑ PLUMBING ❑ SIGN <br />F��ONE <br />S'f�-8z� 3 <br />, ...,.....�... .. ._.,,.,.�... m,.. woness c,nr rio — <br />rHOHc <br />SRdtE <br />GlNER�L CONiRAQOA MAIL Appq[55 CI�V Itl` �HONE LICENSE • <br />S RME GEo�lEI I }g ,CL <br />MECn�WGI COItllUCipq Mnp. ADOnE55 Ci�v Z6' 1'110NE LICENSE • <br />PLUMBM6CONIR�CIOfi MAII.�ODRGSS GIY 211• PnONE IICLIISE� <br />�t ueev{' Sound (�u�-t61n9 yoly !,J. Gts�no Eut�'r �Ze�j -%y3-4S3�- '�u6eTS ly/o� <br />c� ssor o <br />� NEW ❑ ADDITION ❑ ALTEFPTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERi ❑ BUILDING RELOCATION <br />V�LUAi1pN Of WO�M ICO51 01 MAt[ �IALS �LpS L�flON1 <br />UFSGRiBE wOBK <br />USE Of BUi�OiNG <br />�t��e� oESCnirno�+or vnor� <br />� <br />io��Qa�oc�or <br />PROJECI�ODPES; <br />• PLUMBING <br />. NO. <br />WATER <br />e <br />FI7ITURE OR ITEM <br />LAVATORY�WASHBASIN� <br />SHOWER <br />NITCNEN SINK 6 DISP <br />�ISHWl1$HER <br />LAUNORYTRpY <br />CLOTNES WASMER <br />fLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINK �SERVICE — DAR. ETC � <br />��ONf SEipeCe <br />Zn l <br />IONE <br />�� � <br />iOFCON51 <br />V � /� <br />q�bz .� <br />SUB TOTAL <br />VERMIT <br />TOTAL FEE <br />�E�R SEi64�K � <br />2� <br />LOtAi1E4 � <br />7 768 <br />OCCUP�NInJCY G1i0Ui' <br />1 \' � <br />ANPUCA�IONACC B� P�ANS.:IIELe[OBY <br />� �� <br />i <br />S <br />SIOE SEIBACB <br />�a�,��S�rE <br />OYES pN0 <br />ISSUANC[ BY <br />I I1ER[BY CERTIFY THAT I HAVE READ AND EXAMINED THIS �P� <br />PLICATIONANDKNOWTHESAMETO�ETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WOiiK WILL BE COMPLETED WITH WHETHERSPECIFIED HERE• <br />�N OR NOT. THE GRANTING OF A PERMIT DOES NCT PRESUME TO <br />GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STA7E OR LOCAI lAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SGNATURE Of CONLRAC70� 4Ui110R12ED AGENi D4tE <br />X '�_ • i n .. . ,/l - <br />i5 <br />MECHANICAL <br />Q�] <br />TYPE OF E�IUIPMENT <br />A/C — AiHNOLG UNITS — H P <br />�EFRIGERATION UNITS — H.P. EA. <br />BOILERS — OS U /H P. <br />GAS FIREO � C. UNITS — B T.U. <br />FORCED �IR SYSTEMS — OS U. M <br />WAILHEATERS—B.TL. M <br />UNITHEATERS—O.TU. M <br />EVAPORATIVE COOLERS <br />CLOTHES �RVEf�S <br />VENTIIATION FAN <br />RANCEHO00 <br />WATEH NEATEIi <br />wOODSTOVE <br />�AETA� YIBG�(CD3 CHIMNEV <br />FIREPI.ACE INSEfiT <br />MEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PER/AIT <br />TOT�IFEE <br />PIAN t;ME K NUMBER FEE /" <br />��'�i938� ��.. <br />, <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STA7E OUILDING SURCF1nf7GE <br />STATEENERGYSURCHARGE <br />aueuc wonKs <br />TOTAL <br />RECEIPT NO. <br />PROPERTY OWNERS ARE RESPONSIBL[ FOR DETERMINING ALL <br />PROPER7Y LINE LOCATIONS AND RELATED EASEMENTS. <br />