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t.�PLICATION FO1.� <br />,".`»'°"° CONSTRUCTION <br />cm or <br />everett PERMIT <br />BUILDING D[PARTMENT <br />259•8870 TO BE COMPLETED IN INK - PLEASE PRINT <br />everell <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�r <br />4Oi WOR� <br />NEW ❑ ADDITION <br />d iON Or p•Oqc �. W 51 O� M� <br />i <br />�o��eioc�7L� � <br />MM� �DpNL55 G�tY 21P PNONE <br />5-''S/ 5 S'3F�A�/<S�• S�bnh�•.,%ss S�Z�ta 3 3 V�-7/-� � <br />M+�i •ooucss an :�o v��or+e <br />� l i � ( � / l <br />�� i <br />tin nr�oME ucEN5E.1 �3i <br />L'd <br />'ri Q�2�'o 33'/9i7Y /3ofsc-� <br />JP M�ONE LIC[N5�• <br />/ � ! <br />M�R �ODAC55 Gn' L�F PnONE I�CFNSE • <br />�v� � s�,ohe� �'s�f �'p�-s� g6 - �z39 .w.tspi��� <br />� ALTERA7ICN ❑ F7EPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATiON <br />u <br />15� I ��9_ <br />PLUMOING <br />O�US I�BOAI <br />_ � _l I �. <br />. 1_.' �•_+1_ <br />.l <br />UVATORV IWASM BASIN� <br />SMOwEH <br />KITCMEN SINK 6 DISV. <br />URIN�L <br />DPINNING FOUNTAIN <br />FI,pOR ONMN <br />B�LKFLOW PREVENTEAS <br />AOOF DR�INS — A��NLEA�ER$ <br />SINK 1SERVtLE — BnR. ETC.I <br />�RONT $ElB4K <br />o� <br />USEIOHE <br />�� <br />)G <br />� SF <br />sue <br />ITEM <br />'AN(J�D YGF01 <br />^ �/ <br />S10AIE5 <br />Z <br />cov�[s� <br />ir ._ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PUCATION AND KNOW THE SAME TO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WOFK WILI BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITV TO VIOIATE OR CANCEL THE P'�OVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONS7RUCTION. . <br />SIGNATURE OF CONTPI.CiGF OR FUTMOR12ED �GENT OATE <br />X h,,c�,.,' �,�f�` �-/— � l — S � <br />1PPlIG NTSCILYBUSINESSLiCEN5EN0 <br />MECHANICAL <br />NO. TYVE OF EOUIPMENT <br />� A/C—�/MNDLGUNITS—M.P. <br />i FlEFRIGEAATION UNITS — M.P. EA. <br />-' BOILERS—B.T.U.MP. <br />G�5 FIREO A�C. UNITS — 8 T.U. <br />— FORLED ��R SYSTEMS — 8 T.U. M <br />•� WALIHEATERS—BT.U. M <br />UNIT HEATERS — B.T.U. M <br />�— EVAPORATIVECOOLERS <br />CLOTMESOR�ER$ <br />VENTILATION FAN <br />R4NGEMOOD <br />WATER MEATER <br />WOODSTOVE <br />METAI FIREPLACE 8 CMIMNEV <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXMAl15T F�N <br />� <br />s <br />: <br />sme s¢re•c� � <br />S� �o U� <br />�V C�NT SiiE <br />ES ONO <br />NO OF OWELLING UNITS <br />� <br />M�% OGG LOAD <br />N� <br />It1���Y PLFNSIN�CDBY IAt'FR PONISSU�NCI <br />� / '.....�� <br />SUBTOTAI <br />a�nNCnECKNUMBER FEE RECEIVTNO. <br />�s" d 0 �!a d S° 4� <br />—i FEES VALUATION � <br />BUILDING � � � <br />i ` <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE B ILDING SURCHARGE <br />STATEENERGISURCHARGE <br />PUBLIC WORHS <br />TOTAL � <br />PROPERTI' OWNERS ARE RESPONSIOLE FOR DETERMI I� <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />� <br />� <br />