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�'PLICATION FOf.-� <br />'"'E"`°`"" CONSTRUC.TION <br />cm os <br />everett PERM► ' <br />BUIL'u�N��:iEPARTMEN7 TO BE COMPLETED IN INK- PLEASE PRINT <br />259•8810 <br />� <br />❑ DEMOLITION ❑ COM6INATION BUILDING ❑ MECHANICAL <br />2')0� <br />zu, <br />3 <br />❑ PLUMBING ❑ SIGN <br />PNONE <br />"�5-3 -y 2 l i <br />v��oNc CCDI <br />♦RCMITEGI VN Uts�uncn - - ^ ���� � �� � � <br />��li3sG/i�ER BI s 47o i? 1.0 i�w pR Fv 9cao;� ��< 3�3�L <br />NER1L GONIR�CIOA M�IL Ap011E55 Lllv IIP �HONE LILENSE • <br />MEGN�NIG�LfUM�R�LTOfl MLIL�DO�E55 CIIY .'IP FHONE LICENSE <br />PWMBINGCONiR�G10R M�II.��ORE% G�1Y IIP PIIpHf UCENSE• <br />C,,U,(SS OF WORK <br />✓U NEW ❑ A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTO`/E/FRPL.INSERT BUILDING REIOCAfION <br />wwerion or woa� icosr o� M•renu�s rws ��eoni <br />SSOOD P:: � — <br />oeseniaew nK _ � , <br />.., ��.,.�_ o,...,....._ -. <br />P�r � F��-p � N� � r� R,' <br />C� eP l'v Reccv-d ci <br />vnaeer �ooaess ��) <br />� � �= e(N <br />PLUMBING <br />� NO. TYPE OF FI%TURE OR ITEM <br />WATEN CLOSET �TOILET� <br />BATMTUB <br />' UVATORY �WASM BIISINI <br />SMOWEN <br />' 1(ITCHEN SINK d DISP <br />DISHWASMEP <br />UUNDRV TR�Y <br />CLOTHES W�SHER <br />URIN�L <br />DNINKINO FOUNTAIN <br />FIOOR �NAIN <br />B�CKFLOW PREVENTERS <br />ROOFORAINS—AA�NlEA0ER5 � <br />SINK (SERVICE — BRR. ETC � � <br />iuONf $EIB�CK <br />USE ION[ � U ' <br />�? I <br />fYPE Of C Sl <br />-N <br />Si2E O� BI.DG � nJ�LL <br />��i39� 5_F <br />SU9TO�AL <br />PERMIT <br />TOT�LFEE <br />�- <br />REAR SEIB�LN <br />/ <br />'lo <br />�or�nEn <br />�,�%S!.- <br />R•3 <br />Oi STO/R,IES <br />�1� <br />IMEGnW Bv IarpR <br />��, <br />/ <br />i SIiE <br />nno <br />DWFLLING <br />� <br />�e"'C• <br />I HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETfiUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT, TI1E GRANTING OF A PERMIT OOES NOT PRESUME TO <br />GIVE AU7HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFOPMANCE OF CONSTRUCTION. . <br />SIGNAIURE Of CONfBACIGR OR AUIHOR�ZEO AGENi [14TE <br />x /J� - o. �'l ��, <br />,rrur.�Nrsa�reusir�essucErm� �o <br />MECHANICAL <br />PIAN <br />TYPE OF EOUIPMENT <br />A/C — AiMNDLG UNITS — M.P <br />REFRIGERATION UNITS — H P. EA. <br />BOIlEPS — B.T.0 /H P <br />(3AS F�RED R C. UNITS — B.T.U. <br />FOFCED AIR SYSTEMS — B T.U. M EA. <br />WALLMEII7EHS—B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />C10T1/E5 ORVEFS <br />VENTILATIDN FAN <br />RANGEHOOD <br />WA1ER MEATER <br />wOODSTOVE <br />MEfAI FIREPUCE 6 CHIMNEY <br />FIPEPUCE INSERT <br />HEATPUMP <br />GAS PIPtNO <br />FxNAl15T FAN <br />SUBTOTAL <br />TOT�LFEE �1 <br />c NUMOER FEE RECEIPT NO. <br />� c- J��� c <br />FEES VALUATON FE <br />BUIL�ING S <br />Pll1MBING <br />MECNANICAL <br />OTHER <br />STATE BUILDING SURCNARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS AFE RESPONSIBIE FOR DETERMININO AlL <br />PpOPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />