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APPL.ICAi7t�N FOR CONSTRV�TION <br /> PERMIT <br /> rnc C�r-rnmc� <br /> CIiY OF r�t`irlt <br /> � �� everett e <br /> �� � BUILDIN(i DEPl�RTMENT <br /> C F..� • 259�6810 TO BE COMPLETED IN INK—�PLEASE PRINT <br /> � �y n::rrtn iani�nu cnr rm rnarvE <br /> ri � FU�_21fYT 5c�-�-SL Qc��z �!/r�Gt%_l�a� 33f �3.1�0 <br /> K y � 5fruvr r,�.nii eoontss -� -- oi� nr r��oNE <br /> � H� 2 3 o z �U�,e�uT- �.L -- <br /> VJHr ����c�meaonocsieH[n n�ni�nno�Ess air- -nr ��oee <br /> �O Cs] ,i�ni�inf c��rnnnciun - - � �r.un ni�niiPi:; - � - uir--"- - -' in• '-' - �-7�i�oHc ucrusn <br /> H C7 <br /> OH <br /> H � g i4C��M1iGALCONIB�GfOf1 MnItADOP[55 CItY ZIP P110N[ LICENSE• <br /> �j]V �] <br /> � t..� � �IU'.�1➢N[iCO1110�L10� M1ILADI1PC59 CIIY IIp 1'110N[ IICCIbB� <br /> ��J Fi H ciis;ocwortx - - — <br /> O � �"� ❑ ��EW ❑ ADDITION ❑ ALTERATION ❑ REPAIP ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERi ❑ BUILOINGRELOC4TION <br /> n❑❑ dy ifiin�nnem�woaiinonnn�.nTanrtmoouorvir-----'. .... eoN�nartrt:nannurnnrne�n — <br /> g�r�r1 comnnctrmceorwonrc <br /> z y tn --------- - ------- <br /> Il[iL111A[WOIiN tNp$OUME f�ptAG[INVOLVL� <br /> y o �n ��.o-¢� �"� —_ �a��yt( <br /> ruernsmus[ornmionm / � � IHEREDYCLq11fY711AiIIlAV[RE�DAIJDE%AMINEDTHISAPPLICA710HAND <br /> —�a�(�(, C[�SS �Qpary� ( __ KNOW:11[SnMETOB[iRUEA1JDCORREGT.ALLPROVI510N50FLAlN3pND <br /> i[r.n�u[sciuruouorri�ortntt�s�onrvu[lowonnnecArounco�`u',� - ORDItJANGCSGOVGPNINGT1115TVP[OFtVORKWILLBECOAIPLETEOWITH <br /> WIIEI HER SPECIFI[D I If.REIN OR NOT.TNE GRANTING OF A PflR611T DO[S NOT <br /> PRESUME TOGIVE AU1110f71T\'IOVIOLAT[OR CANCR TH[PROVISIONSJF <br /> ioi_ mecK___ or ___ ._________._. - AIJYOTII@RS�NEORLOCALLAIVREGULA7INGCONSTRUCiIONOfiTHEPER� <br /> FORMANC[OFGONSINUG110N INATIAA7AUTHORIZGDBV7HEOWNEROF <br /> TNIS PIiOPGRiV TO Ff HFORh7 iH[WORK FOfi WHICH APPLIC4TION 1S fdADE <br /> -- - �ND I COMPLV WI7!1 711E S1AlE CONTR4CWH5 lAW 1027 RGW AND <br /> 29G200 WAG <br /> +�m�NU�atorcnrNmr,�nu,mranuonprnn.;[rv� onrE <br /> — —__—_ . <br /> �'�l(,� �>i�� �Q�� �-.� (\� � - 7 - - <br /> 1'llp�1 I� F-�' ✓_ _ ___ _ _ /F�/ <br /> I � .� � � � nnpLlf.AMSCII� �IISINIpSUUqSCNOn J�OSiN[Si11nMC <br /> � . <br /> PLUMUING MECN�NIC�L <br /> II NO. TVI'E OF FI%TURE OR ITEM FEE Nfi. 7YPE OF EOUIPMENT FEE <br /> �' N'A7ERrLOSET�TO�LED NC-NIINOLGUNI7S-IIP. <br /> —,� �ATHTUD -- -��----- - � � ----- FORCEDAIRSYS7EM5-B.T.U. MEA �— --� <br /> -- __'--- - _._ -- _—— __'_-_ '. '__" <br /> � LAVATORY�\YASH ASIN� UN HUTERS UT.U. M _ <br /> '_-_ -__._. _ -_ — <br /> I 1 SI/OWER CLO p+1[SDRYCfS <br /> ' r KITC LNSINK DISR _ _ _ __ _ V[NI11.AilONf�N _ ._ _ _ <br /> � � <br /> DISH\ SH[ RANGP}HOO _ _ <br /> ��' _ LAUNO_V_RAV __'_ __ _ _ WAT[fiINU R . .__ _____ <br /> CLOTH VASNER WOODSI E <br /> ' ' — � � ____ _ _ METAL I� EPLACE 8 CHIMNEY - _ <br /> O NKING FOU 7J(IN FIREP E INSflfiT <br /> I _ IOORDRAIN � ____ HEAT �UMR '�'-�— _. <br /> i BACKF�OIVPREVEIJTEAS _ -_ _ G PIPING _ _- <br /> ROO�DRAINS-RAINLEADERS E%IIAUST FAN <br /> SINK�SERVICE-BAR.ETCJ ______ _. <br /> 0 ----- - - - _ <br /> � - -- - <br /> '�� sue rorni s sue Torn� a <br /> '�I PEiiMli E PERMIT 5 � <br /> � TOiALFEE 5 TOTALFEE E <br /> 1�101115[IU�CN f1G�RiC�OACN SNESCIO/�f.Y 1'UNCNCCNHOMO[N fEE 11ECEIPTHO. <br /> irirzorve iarnnu � - vncnrvism - FEES VAWATION FEE <br /> n res �yC:r+o <br /> i.r[orr.ou5t occuPnHcrcnour NoorowuLn�cuuns BUILDING � <br /> niw�,vaoieinctuAy- � � <br /> � �-� PLUM�ING _ <br /> �:���coreiea - Noors.oiaas- -n�.rar occ.io�o <br /> i i r MECHANICAL <br /> �K7.fzJG� � _ X" _— — —' <br /> ��uc�aur.mmior� OTNER <br /> nr,c s�nirvK�[nsnrouw[o ❑ve5 �{i+o __� _ STATE�UILDING SURCHqqGE ��// J <br /> _ _'_'_—_. . 1- _ _ <br /> SiATEENERGVSURCHARGE <br /> iiriicmia�Acr.or nnusn�rnnr-- - -� -- - <br /> PUDLIC WORNS <br /> ��^'' TOTAL � � <br />