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� <br />� <br />t.�'PLICATION FOR <br />'^'`w'°'"" CONSTRUCTION <br />�,n oF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />c�nciun� innN ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />�■ <br />❑ PLUMBING ❑ SIGN <br />oWMeiN . [oNlr���oR <br />u.aenm�ess — enr zio rno��c uCENSE• <br />:L�$$O! W01�N <br />❑ NE�Y ❑ �DOIiION ❑ ALTERATiON ❑ HEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT <br />..� ,�.nnu nr wonr rcost ar r+uen�us r�us ��n�ni <br />oun <br />icee� oesemm�or� o� ��+o�•i <br />w�.-- s�ot�—or <br />!(`, � .� �/'-� /�1.��'��J <br />rpoJEGl�DunE55 " <br />PLUMBING � . <br />NO. TYPE OF FIxTURE <br />W�iER CLOSET �TOILE7) <br />BATNiUO <br />LAVATORY (WASM BASIN) <br />SMOwEf1 <br />NITCNEN SINK d OISP <br />OISHW�SHER <br />�AUNORYTRAY <br />CLOTHES WASNER <br />Uf11NAL <br />n(IINNING FOUIITAIN <br />FLOOR O�A�N <br />B�CRFIOW PREVENTE115 <br />ROOF DRAIN$ — AAV iLEAOG <br />SR�N �SERVICE— OAR. ETC � <br />� ��Oill SE�O�f.K <br />BUILDING RELOCATION <br />i HER[OY CERI�IFY THAT I HAVE PEAD AND EXAMINED TIitS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF IAWSANDORDINANCESGOVERNING THISTVPE <br />Of WORK WILL BE COMPLETEC7 WITN WIiET11ER SPECIFIED HERE• <br />Ik OR NOT. iHE GRANTING OF A PERMITDOES NOi PRESUME i0 <br />GIVE AUTHORIiY TO V!OLATE OR CANCEL THE PNOVISIONS OF <br />ANY OTfiC-R STATE OR LOCAL LAW REGULl�TING CONSTRUCTION <br />OR TIiE PERFORMANCE OF CONSTRUCTION. . <br />sior+niune or conin�crun on nun�onizeo nce��� nate <br />X v/ /,�n e 'S ^��_ ��V <br />rs cnr ausiiie ss ucTr�s2 No <br />MECHANICAL <br />��E�� FEE NO. TYPE OF EOUIPMF <br />AiC — A/��NOLG UNITS — N P <br />IIEF�IGEf1ATION UNITS —11 P. EA <br />f1011E�5 — B.T U /11 P <br />GAS FIPED A C. UNITS — OS.U. <br />FORCED AIR SYSTEMS — � T U. <br />WALI M�ATEliS — �.T V. <br />UNIT MEnTERS — �S.V <br />EVAPO�/.TIVE COOLEfiS <br />CLOTI�ES 09YE�5 <br />VENTILATION FAN <br />RnNGE1100D <br />W A1 Efl HEATEf1 <br />WOOOSTOVE <br />METAL FIREPIACE d C�aIMNEY <br />FIREPIACE INSERT <br />I/EAT PUMP <br />GAS PIPINC <br />E%IIAUST FAN <br />SUOTOTAI <br />PERMIT <br />iOTALFEE <br />IIE�� SE�B�CN <br />n <br />n��rnccunnncr, n. Iriri�s <br />L <br />VAC�NISrtE <br />UYE$ IlNO <br />ov <br />BUB�OTAL <br />PCIIMIT <br />TOTALFEE <br />PLAN CIIEGN NUMOEfI I FCE <br />M EA. <br />M <br />M <br />Fee <br />RECEIPT NO. <br />FEES VALUATION FEE <br />�UILDING 5 <br />PLUM[31NG <br />MEGNANICAL <br />OTHER <br />STATE BUILOING SURCN�RGE <br />STAIE ENEfiGV SU(7CHnRGE <br />PUBLIC WO^NS <br />TOTAL <br />PfiOf [RTY OWNERS ��E RES�ONSIBLE FOR UETEPMININO ALL <br />FROP[RTY LIIJE LOCATIONS AND RELATED EASENENTS. <br />