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f,PPLICATION FO1. ���,en <br />,".E"'°'"" CONSTRUCTION O <br />an or <br />everett PERMIT <br />BUILDING DEPART�AENT TO BE COMPLETED IN INK - PLEnSE PRINT <br />25a` 9�10 <br />[1EMOLITIOV _ O CUMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />OW„Lp ,,(' M�IL �DDA[55 CIfY IIP PMONE <br />�4 l�IVI �i�1E/ (L� y3��� S ��%lI fiV L`-✓ ��`�vj v o c 5'� �.J ��� <br />.��Junr�nnotS�ONER ��n��DNE55 �rv 1 <br />PLl11ABIN.LOMiP�C10P IAeil �DOnE55 CIiV 2iP PnON[ IICENSL • �. <br />LL�SS Of WORK ��� <br />� NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DLMOLITIOIJ ❑ WOODSTOVE/FRPL.145ERT ❑ BUILDING RELOCATION <br />.�j' /•�� � <br />reseniee wonK <br />NEU/ Cl /,NI�iE�I <br />❑SE OF BwiDiNG - <br />TR{�[{ ClF <br />t[O�L�ESCRiPi�OrvoFa or[aTr�SMowNoclnwOnsiLb� <br />ioi_ ei oc,___—or — <br />Hoiccr.00ncss <br />�y31�i � 1�� �' /���_ <br />PLUMBING � <br />NO. TYPE OF FII(TURE OR ITEM <br />W�TER CLOSET �TOIIET� <br />BATHTUD <br />LAVAiORV IH'ASN B�SINI <br />SMOwER <br />NITCMEN SINK S OISP <br />DISMWASMEA <br />LAUNDRVTRAV <br />CLOTMES WASHER <br />UR�NAL <br />DRINKWG fOUNTAIN <br />FLOOR DRAIN <br />BACNFLOw PREVENTERS <br />ROOF ORAINS — HA�NLEADEPS <br />SINK �SERVICE — OnR. ETC I <br />SUBTOTAL f <br />PERMIT t <br />TOTAL FEE % <br />.i�pNiSEtp�Ck - —� RC�R 5[iB�LK SIDG SE/O�C.. <br />i6E IONE ��T �AE� V�CANi SIiE <br />❑YES ONO <br />rVP[O(CONSt OCCl1PANGYGP011P NOOGDWfI <br />,,.� n�.., nn u(1 OF SIONIES MR% OCL \( <br />ICAl10N�CC OY <br />I HER[BY GERTIFY THAT I HAVE READ ANU EXAMINED THIS AP� <br />PLICATION AND KNOW TNE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVER�IING THIS TYPE <br />OF N'ORK WILL BE COMPLETEQ WITH WIIETHER SPECIFIED HLRE• <br />IN OR NOT. TI1E GRANTING OF � PERMIT DOES NOT PRESUME TO <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 />SIGN4IUNE OI CONiR�CiON OR ApTHOPIZ[� AGEM D4iE <br />/� �9 / /- <br />X �-�'.,t11_ �J i_c/ei�.�� <br />�IISIN[ SS 1 �CC <br />MECMANICAL <br />FEE NO. TVPE OF EOUIP'� <br />A/C — AOiNOLG UNITS — H P. <br />REFRIGERATION UNITS — H P <br />DOILERS — 0.T U./N P <br />GAS FIRED A C. UNITS — BSL. <br />FORCED Alfi SVSTEMS — B T U <br />Wp�� MEATERS — B.T U <br />UNIT HEATERS — BS.0 <br />EVAPOAP.TIVE COOLERS <br />CLOTME9 DRYERS <br />VENTILATION FAN <br />RANGEMO00 <br />WATCP MEATEfl <br />WOODSTOVE <br />METAI FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />MEA7' PUMP <br />GP$ PIPING <br />E%MAUSTFAN <br />errn ron issueHce er <br />SUO TOTRL <br />PEI7MIT <br />TOT�LFEE <br />V�ANGMECNNUMBER IFF.E <br />BUILDING S <br />PLUM6ING <br />MECMANICAL <br />OTl1ER <br />STATE BUILOING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M EA. <br />M <br />M <br />RECEIPT NO. <br />PROPERTV �INE LOCAiIONS AND RELATED E SEAIENTSING ALL <br />