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�n. f.v.prNn <br />��,� o. <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />� �. <br />�.PPLICATION FOI. <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPIETED IN INK • PLEASE PRINT <br />.! `A F4l ( JN19PL1pP Auil +PPIII .'. � � �.� iu �`r�ONI ULEN9C • <br />�tJ I s1 o h <br />a�n��v�:.�i crHnu.-�rnt �� �nneiss ❑iv � m�nru[ uc[r��,r. <br />JI'�l�s K«7'rN� 8°rf M•a��� b,r (3�61.'�?�rA� 9Yz�S <br />rius�pw�lco+��aer�nn w.i eooal�_sy cnv ,-�r rnoHr uctrae. <br />Ct�stio� u0n.. <br />❑ NEk' ❑ AD�ITION ❑ AITERATION ❑ REPAIF ❑ DGMOLIIIGN ❑ WDODSTOVE/FRPLINSERT ❑ BUILDING FELOCATION <br />v�i u�nor� o� �,��•,� os q� M�rznuis ri.us i unnu� <br />rn sc��ei. �vou. <br />uao� ocno�� I HER[BY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALI <br />im•iocsa���uovo�onarruir�s�.oa�aeunwoA•�*�r.�rouncovirs PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BECOMPLETEQ WITH WHETNER SPECIFIED HERE• <br />io,—niocti—o� IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />5711 e�Z1�cL_� <br />R1.UMlING <br />NO. T'PE OP flIlTURE <br />W�TER CLOSR ITOILET� <br />BATMTUB <br />UVATOaY �WASN BI15�N� <br />SHOWER <br />1(ITCMEN SINK 6 DISP <br />DISNW�SMEF <br />UUNDRY TR�Y <br />CLUTME$ W�SMER <br />URIN�L <br />ORINNING FOUNTAIN <br />FLOOR ON��N <br />BACKFLOW R7EVENTERS <br />ROOF OR�INS — iiAINLEAOE <br />SINN �SEP410E — BAR. ETC 1 <br />� RO�R SHO�CK <br />tISL IJNE <br />n�:r„�, ..�ip•i o./. [3v <br />� <br />SUlTOTAI <br />PERMIT <br />TOTALFEE <br />IE�A SNB�C+ <br />o; �r.0 <br />)CCUPAHCY GROUP <br />JO O� 510PIC5 <br />IED � YES ❑ <br />viqNS CNEf,eEo Br <br />GIVE AUTHORITY TO VIOIATE OR CANCEL THE Pi70VISIONS OF <br />AIJY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEPFORMANCE OF CONSTRUCTION. . <br />SIGNAiUHE OF �pNf4iAf,iGR O� AUTHORII[� AG[NL paiE <br />X Gor.�. p.�,.�- � aa -g <br />ICPUL4NTtiC�tV pp5�N1 55 UCLHSC NO <br />MECHANICAL <br />NO. TYPE OF ECUIPMENT <br />A/C — A/��NOLG UNITS — M P <br />REFRIGEPATION UNITS — N P. EA. <br />DOILERS — 9.TL iH P <br />GAS FIRED A C. UNITS — B T U. <br />FOPCED nIR SYSTEMS — B T U. V17� <br />WALLHEATERS—BTU. M <br />UNITHEATEAS—BTU M <br />EyqPORATWECOOlERS <br />CLOTNESOPYERS <br />VENTILATION FAN <br />RpNGEMOOD <br />WATERHEATEfi �� <br />WOODSTOVE <br />METAI FIREPLACE S CMIMNE� <br />FIREPLACE INSERT <br />MEAT PUMP <br />GAS PIPING % <br />E%HAUSiFAN <br />t ' SUlTOTAL <br />s P[RMIT <br />� �i— � TOTAL FEE <br />._____._. IPI.quCNECNNUMBER �FEE <br />VAUNi S�iE <br />]VES CNO <br />i0A0 <br />Br <br />RECEIPT NO. <br />FEES VALUATIOn rcc <br />BUiLDING S <br />PL11M81NG <br />MECNANICAL � <br />OTHER _ <br />$TATE BUIIDING SURCHARGE <br />STATEENERGYSURCNARGE <br />PUBLIC �'�'ORKS <br />TOTAL � <br />PROP[RTV O�UNERS AF7[ RESPONSIBLE FOR DETEflMINING ALL <br />PROPE(7TY LIN[ LOCATIONS AND RELATED EASEMENTS <br />