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�PPLICATION FOIr% <br />fMEr�ryr� CONSTRU�:TIGN <br />CITI OF <br />everett PERh� ,T <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK - PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINA't10N O BUILDING �ECHANICAL ❑ PLUMBING ❑ SIGN <br />M��L�D�RESS LIr 21P PNONE <br />���!-✓1�5 �'�.riC�t. J�OI (n Cvi lm r nG1�1 ��IPYEtf ��201 252 -/C'o C'o_ U _ <br />•PCNrtECTOROE510NEA M�iL�00BE55 C�iV 2 PHONC <br />GENERIL f.OMa�GtON M�il �UORE55 Ciiv Lm euDNE UCENSE • <br />;L�SS Oi'YORK <br />❑ NE\V ❑ ADO1710N <br />7EFATION ❑ REPFIR ❑ DEMOLIiION ❑ WOODSTOVE/Ff.i'L.INSERT ❑ BUILDING RELOCATION <br />G1IAL11 <br />� PLUMBINO '" <br />NO. TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET (TOILEi� <br />� BATHTUB <br />� LAVATORY�WASNB�SINI <br />I <br />� SHOwER <br />KITCMEN SINK 6 OI.^,P. <br />� DISMWASMER <br />. UUNDRV TPI1Y <br />CLO7HES w�SHfH <br />URINAL <br />. DRINKING FOUNTA�N <br />. FLOOR DRA1N <br />' BACKFLOW PPEVENTERS <br />�, ROOFDRAINS—RAINLEADERS <br />SINN �SERVICE — BAR, ETCJ <br />i <br />I• <br />i; <br />8USTOTAL f <br />PERMIT f <br />' TOTALFEE � <br />tPDNT5Ei8�CK �nP�R SETBAGN S�DE <br />� <br />115E 20NE LOt ARE� <br />TYfEOFpONST OCCUPANCYGROUP <br />SIZE Oi BlDO NO OF $LOPiE9 <br />FIFE SPRINKLERS REOUIfiED ❑ YES ❑ <br />AVplICR110N PLC B� PL�NSCHEGNEO BY <br />V�C�NTSrtE <br />OYES ONO <br />NO OV OWFL <br />MAM <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE- <br />IN OR NOT. THE GRA�TING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL TI1E PROVISIONS OF <br />ANY OiHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCF OF CONS'RUCTION, . <br />$IGNATURE Of CONIR�CIOR OR AVTNORIZC� RGENi DRTE <br />X LP _ l�,.l� � 2IC� I�i <br />MECMANICAL <br />iEE NO. TYVE OF EOUII <br />PiC — AiHNOLG UNITS — M P. <br />REFFIGERATION UNITS — M P <br />BOILEPS — B.T.0 /H P. <br />G�S FIRED A�C. UNITS — B.T.I <br />fORCED �IR SVSTEMS — B T.I <br />WALL HEATEAS — B.T.U. <br />UNIT HEO.TERS — B.T. V <br />EVAPORATIVE COOLERS <br />CLOTMESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />W�TER HEATER <br />WOODSTOVE <br />METAI FIREPIACE 8 CHIMNE <br />FIREPUCE INSEPT <br />MEATPUMP <br />�GAS PIPING <br />E%HRUSTFAN <br />fORI55U�NCEBY <br />. ,..i:, . .. . . , . , . . . . . i <br />P[RMIT <br />TOT�LI <br />PLANCMELKNUMBER IFEE <br />M EA. <br />M <br />M <br />RECEIPT NO. <br />FEES VALUN71on rcc <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCNARGE <br />STATEENERGYSUNCNANGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTV OWNERS ARE RESPONSIBLE FOR OETERMINING ALL <br />PROPERTV LINE LOCAiIONS AND RcLATED EASEMENiS. <br />