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m. e.+rpn�n <br />n*r ov <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />� <br />ArPLICATION FOR <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�Aowrvea M+ii�ooness eirv ziv oroNc <br />Y1 <br />KIRK f}, IiEYE� I�U,3�X }/13 t-�rRfTT,e.A. 9iLc3 �53-63ZG <br />^��Ga1LCiORULS�GYER MM�IDOWE55 GIiV ZIP PNONE <br />�d.vLMI'LGONiFA�C10R ` MHt�DORE55 C'�V ZiP or�pN[ �iCb�SE• <br />� ^l�� lt.I�f�En <br />bL(HLq�f,4t CONiNiLlpq MFIL �f10AE5$ C�tY ZI� p114ryE LIC[YSF • <br />PWMBIN.COHiR�GiOR M�ILPppRL55 Clh ZIP p11pNE liCL115E• <br />cu55 Ai woarc <br />❑ NEW � ADOITION ❑ ALTEAATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFPL.INSERT L� BUILDING FEIOCATION <br />velU�tiONOI WOn. {,051 � Mat[PiAL5o�u51<90R� <br />� —�--' l� 3k0=e <br />orsca�ei woe« <br />X /GX Zp ADD�t/�U <br />� <br />� �o�� sli <br />JWN DELOW OR �1TALr� FOUR CO�iES� <br />O±' LnwaLL D/✓. � . <br />VOL� S ef P�AtS PG <br />FUrRE%i i <br />XOpOIECT�DDFE55 <br />PLUMBING <br />NO. TYPE OF FlI(TURE OR <br />WATEP CLOSET �TOILET� <br />BATMTUB <br />UVATORY IW�SM BASIN� <br />SHOWER <br />KITCMEN SINK 8 DISP <br />URINAL <br />ORINNING FOUNTAIN <br />fLOOR ORAIN <br />BACKFLOW VREVENTERS <br />ROOF DRAINS —RAINLE/ <br />SINK �SERVICE —BAR. E7 <br />� �+UYI $EiBeCn <br />US( IUNE <br />�� � <br />rv�[ o� rOvs* <br />�� N <br />s:co�o� u <br />9�f� _A� <br />I HERC-BY CERTIFV THAT I HAVE READ AND EXAMWED THIS Ap� <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORREC7. �LL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTVPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE-� <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO V!OLATE OR CANCEL THE PROVISIOMS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNFIURE OP CONiR4CTCR OF At1THOR�2E0 AG[NT D4TE <br />X ��;.E ,�_ �s� 3 L P-YP <br />NP�LIGNi5C1iY8U51NE55UCf115[ NO <br />�4 vc- FvFR E7 `+-d <br />MECNANICAL <br />:M FEE NO. TYPEOFEOUIi <br />SUB TOTAI� <br />PERMIT f <br />TOTAL FEE f <br />R SCiSeC[ SiOE SEiB�C <br />Z�i �i <br />AA�A � V4CANi51fi <br />/ � �Z,.0 �vE5�10 <br />'�UPANLYGFOUP NOOFOWlI <br />R- 3 , <br />"/NO Ov SLOPi[5 <br />�-/3.wr <br />/ � <br />i <br />�L <br />A/C — A/HNDLG lJN1T5 — M P <br />REFRIGERATION UNITS — M P EA. <br />BOIlERS — 6.T U M P. <br />GAS fIREO A C. UNITS — BS.U. <br />FORCED nIR SVSTEMS — 8 TL. M <br />WALLHEA7ER5—BS.U. M <br />UNIT HEATENS — B.T.U. M <br />EVAPORATIVE COOlERS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERHEATEP <br />WOODSTOVE <br />METAL FIREPLACE d CMIMNEV <br />FIREPLALEINSERT <br />MEATPUMP <br />GA$ PIPING <br />EXMAUSTFPN <br />SUS TOT11L <br />P[RWT <br />TOTALFEE <br />�LnN CI+ECK NUMOER FEE <br />��� �.G6 5'0 5`—° <br />BUIL�ING <br />awMeiNc <br />MECMANICAL <br />OTMEfl I?�i{�/5���� <br />STATE BUILOING SUPCHARG <br />STAT[ENERGYSURCHARGE <br />PUBUC WORKS <br />TOTAL <br />3 <br />RECEIPT NO. <br />�"»S <br />FEE <br />�� <br />PROPERTY OWNERS ARE (7ESPONSIBLE FOR DETERMINING ALL <br />PROPER7Y LINE LOCATIONSAND RELATED EASEMENTS. <br />