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- � <br />A�'PLICAT�ON FOI� <br />'°""'°�'° CONSTRI;t;T10N <br />��..o� <br />everett PERMIT <br />9UILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ CAMBINATION $tBUILDING ❑ MECHANICAL � PLUMBING <br />❑ SIGN <br />UqytN M�II �PIIULSS bn♦ ni n�Vrvl. <br />�i`EC�� ���nN`r f9'lE �`'7x1T� L��Rt'lT 9�20 1 33%1292 <br />•��f��IRC1OBl`lS4iHtH MLM1�IIDH(S$ CIiY II1' i�HONL <br />�f1h.-1� Wor - 3��-'{873 <br />,.1 `.1. Wl � J�.1�aLiJn M�il af1DRC55 CRv DP nPONt ULtISf • <br />5 ft M E <br />iVLCn�Wf.�L CON1Ne(;ii�q M�R AI)DRESY CrtY LP nryON! L�ClMSC • <br />41UMP�NqCCNiF�Gl�lo MUL1004f5F OiV .'6` Pi�pN[ uCU�St• <br />1:11,SSllt N(1P� <br />L� NEW � AODItION ❑ Al7ERAT10N ❑ REPAIR ❑ O[MOLITION ❑ WOODSTOVE/FRP� INSERT ❑ BUILDING FEIOGATION <br />t4 UOj�IN Of 1AO�� .CO51 OI M11CA4LG PLUS V130Ri /^ <br />V �c7 `.7� ��LI .- l JL J <br />lU <br />R A C'-, E, 1' <br />�o��� �p� <br />nioc" JIWor <br />' �/� �� <br />PLUM8ING <br />NO. T'PE Of fl1ITUN <br />WI1iER CLOSET I�OILETI <br />8�7MTUB <br />UVATORY �W�SN B�SINI <br />SNOwER <br />NITGMEN �INK 6 DISP <br />LAUNDRV TR�Y <br />CLOTMES WASHER <br />URIN�L <br />OA�NKING FOUNTAIN <br />fLOON DNAIN <br />BACKFLOW PNEVENTERS <br />ROOF DR�INS - R�INLEAOE <br />SINK ISERVICE - BAR. ETC 1 <br />SUIITOTAL <br />PERMIT <br />TOTALFEE <br />Yp'RSE1flAU� �lNP <br />� , <br />��z�ropnt ior•ntn <br />h - �- <br />rV�,COi�t�Si OCCUP411CYGA( <br />Y _�,/ ,y_ <br />SV[0�9i0G NOO�S�OPIES <br />3A� s� � <br />vV q5 <br />coo�es <br />FEE <br />� <br />f <br />f <br />SiDF SCiB�Cn <br />�.�sr S�rE <br />L'YES �✓i0 <br />i� <br />rv9 Of OWFLL <br />� <br />MAK OCC .O� <br />EGKCDBv �PfH�0a�55UANGEAv <br />� <br />f? �1 <br />I HER[BY CERT�FY TNAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LHWS AND ORDINANCESGOVERNING THIS TYPE <br />OF WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY ?O VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANGE OF CONSTRUCTION. <br />SiGN4TURE Oi� CONIRnCiCN OR AUiHORiZEO AGENi p4TE <br />X�� �N -� � T -J �O� <br />�nP�iUNrS Utv BuS�t+ESs uCVBE No <br />MECHANICAL <br />T'►E OF EOUIVMENT <br />A/C - AiMNOLG UNITS - M P <br />RFFRIC.ERATIONl1N1T5-NP EA. <br />001LER5-BTU/HP. <br />G�5 FIRED A C. UNITS - B T.U. <br />FORCEO AIR $VSTEMS - 8 T U. <br />WA�� MEATERS - 8 T.0 <br />UNIT HEATERS - B.T.0 <br />EVPPOPATIVECOOLEF$ <br />CLOTHES DRYERS <br />VENTIUTION FAN <br />RANGEMOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIRE7LACF.INSERT <br />HEATPUMP <br />GAS PIPING <br />E%MAUSTFAN <br />SU! TOTAI <br />PEPMIT <br />PIAN CMEL NUM6EH <br />$g 1 q 4s 6 <br />FEES <br />BUIL�ING <br />PLUMBING <br />MECHANICAL <br />STAT�OTNEF <br />ING SURCMARG <br />STATEENERG�SUFCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M EA. <br />M <br />M <br />FEE�� n� AECEIPTNO. ���/� <br />� 1 G�l\ <br />.......�.... J�t <br />/ <br />PROPF.RTV OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERN LINE LOCATIONS AND RELATED EASEMENTS. <br />