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;-.f'PLICATION FO�.' <br />'"'`�°'"" CONSTRUCTION <br />arv or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />owr�ea M�a�oon[ss . Grv zir <br />i,7,//_.,,� .f�vei:, P7/� �ili/.�/Y�/A/u �l�� <br />ntrrcau corna.c�oa <br />PLUMBINU <br />O SIGN <br />MECN�N�UI CONIR�CTOf1 M�R ��i�BE59 ��^ "' "�"'" ""`�"` � <br />pWMBI11000�1�11�G1Of1� M�II.�ODRESS CIIY lll` P�IOtIE LICEII[C• <br />�i%�L-!s� /L��i�l/>�i�4 '32;���,�rJQf% s�sF Ef�,�� 9s1��.4 �'�-.�4�" �1�� . � <br />GU550f WOAM <br />❑ NE�N �AOOITION ❑ ALTERATION 7 REPAIR ❑ DEMOLIIION ❑ WOODStOVE/FRPL.INSLRT ❑ BWLOINU REIOCnTtON <br />�o�—ewcK—or_ <br />PROJECI�DORE55 <br />R2/�1 �Cct�L/=/� L� <br />v�uMeiNo <br />NO. TYPE OF FIItTI <br />W�TEP CLOSET ITOILET� <br />OATHTUB <br />LAV�TORYIW�SMB�SIN <br />SHOwEN <br />KITCHEN SINK 6 OISP. <br />DISHWASMER <br />UUNDRV TRAV <br />CLOTHES WASHER <br />UAINAI <br />BACKFLON�PFEVENTEFS <br />pOOF DHAINS — f7AINLEAO <br />S�NK ISERVICE — BA0. ETC <br />SUS TOTAL <br />rvo[ <br />IVVIICF�lON1{;C BV <br />V�L�NT SIIE <br />UYES �NO <br />B� <br />I NER[BY CERTIFV THAT I HAVE READ AND E%AMINEO THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. �LL <br />PHOVISIONS OF LAN'SAND ORDINANCESGOVERNING TFiIS TVPE <br />OF WORK WILL BE COMPlEiEO WITH WHEiHER SPECIFIED HERE <br />IN OR NOT. THE GRANiING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br />ANY OTHEfi STA1E OR LOCAL LAW REOULATIN6CONSTRUCTION <br />OR THE PEFFORMANCE OF CONSTRUCTION. A. e� <br />SION�TURE O( CONIRRCIOR OR AUt110NIZED AGENT ❑RTE _I ��7 � lJ 7 <br />X �/.� . . _ r�i ( n �._ ,� <br />IR[ ND <br />MECMANICAL <br />TVPE OF EOUII <br />A/L — ��HNOLO VNITS — N P. <br />BOILERS — B.T.U.rH P. <br />6AS FIRED A C. UNITS — B.T.U. <br />FOPCEO AIP SY57EM5 — B.T.U. <br />WALL HEATEF$ — B T U. <br />UNIT NEATEFS — B.i.U. <br />EVAPORATIVE COOLEflS <br />CL0T11E5 ORYERS <br />VENTILATION FAN <br />pANGEH00� <br />WOODSTOVE <br />METAL FIREPUCE <br />FIFEPLACEINSERT <br />FAN <br />SUliOTAL <br />P[RMIT <br />PLAN CHECK NUNBEH I FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAI <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHAf7GE <br />PU9LIC WORKS <br />TOTAL <br />M <br />M <br />M <br />FE! <br />RECEIPT NO. <br />PROPERTV OWNERS ARE RESPONSIBLE FOR OETERMININO ALL <br />PPOPERTY LINE IOCATiONS AND RELAi ED EASEMENTB. <br />