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� � <br />,.PPLICATION FO1. <br />'".E"�"'° CpNSTRUCTION <br />a*. or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE CO'�PLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />o�v�y�;, . �_ n�ui.00s�ss D.A- ` /�� cn�� m, <br />1� . 11�N l)1 ��(iYl l! <br />I��{µNILlj1N1 <br />M�R <br />nv - :ir <br />�� <br />❑ PLUMBING ❑ SIGN <br />r��oru. <br />� �5,773�' <br />To�n <br />ai..r�r.[ i 1l c��Cc • <br />� �'f )�i0i� -e.1.1 � /�-�n p.v-trcivL-, i� a � • <br />wr��.a�; ,e:n�.cu,a r..n�.isnwass C��v Lr i���or�e �.�c[r+s[. <br />�.n+ t�v w�p�+[ ���ErSE • <br />1'll�MpiMLiOVII:LLlOf1 AIAp,ADPRC:iS � <br />:1�5501 KOF. <br />❑ NEW ❑ �DOITION ❑ ALTERAiION ❑ REPAIR ❑ DEMOLI710N ❑ WOODSTOV[fFRPLINSERT BUILDING RELOCATION <br />�u u..�a� o� wna. �c.osi o� ��.i�nu�s rius i•t+ne� <br />w'— <br />VLUMSING <br />` t'�cci . <br />OCLON' <br />W�TER CLOSET �TOILET� <br />B�THTUB <br />UVATORY (W�SM BAS!N� <br />SHOwEF <br />KITCMEN SINK d DISP <br />DISMW�SMEN <br />�AUNDNYTRAY <br />CLOTMES W�SHER <br />URIN�L <br />OA�NKING FOUNTA�N <br />FIOOA ORAIN <br />BACKFLOW �EVENTERS <br />ROOF DAAIN$ - RA�NL[ADE <br />SINK �SERVICE - BAR. ETC 1 <br />�uoh*Sf�O�C� <br />u5! IUNL <br />� '�L G� COYS1 <br />S.IE Or Bl D6 <br />ITEM <br />SUSTOT�I <br />PERMIT <br />TOT�I FEE <br />q[AR [EiB�CK <br />lOiPnF.• <br />NO <br />FIRE SPRLVKLERS REOU�RLD J VES ❑ NO <br />fOUR <br />��h.,�o��� a - �.� ���t:e�,� �D�_ �a��h� <br />I HER[BY CEFiTIFV THAT I HAVE READ AND EXAMINEO THIS AF� <br />PLICATION AND KNOW THE SAME TO BE TRUE APIDCORREC7. All <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHEHSPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES hOT PRESUME TO <br />GNE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />31�KATUAE O� CONif:nCiGa OR AU/i�nORi$EO AGENi D4iE <br />_ . /1 / I . /1. � _ �r <br />sm[sunwn <br />V�C�NtSrtE <br />❑VES :]NO <br />NO OL OWFLLI4G l� <br />u.x nr.c .ono <br />��p�':. �-�ya�_`.b+ PLRNSGMECNE�Bv �>�rnr011K5u�HG[Ilv <br />i ��� <br />anp�/"elrticnruu+�nun���....���.,, � � ( <br />U <br />MECMANICAL <br />,1/C - A/HNOLG UNITS - H P � <br />NEFRIGER4TION UtJITS - M P EA. _ <br />BOILERS-B.TU�HP. _ <br />GAS fIRED A C. UNITS - B T.0 <br />FORCED AIR $YSTEMS - B T U. M�1A. <br />WA�LMEATERS-BS.0 �� <br />UNITHEAfERS -BTL ��� <br />EVI.PORATIVE CJOLERS _ <br />CLCiME50HYER5 <br />VENTILATION FAN <br />RANGEMOOD �_ <br />W�TERMEATER � <br />wOOD570�E <br />METAL FIREPLACE d CNIMNEY <br />FlREPLACEINSERT <br />MEATPUMP <br />GAS PIPING <br />I E%HPUSTFAN <br />T�— SUlTOTAL �J <br />'—t-- P[NMIT > <br />TOTALfEE <br />p�Ary �MECh NUMBER I FEE I RECEIPT NC. <br />�UILD�NG g <br />PLUM�ING <br />MECHANICAL � <br />OTHER <br />STAiE BUILDING SUPCHAPGE <br />STATEENERGYSURCHAAGE ��_ <br />PU�LIC WORKS <br />TOTAL � <br />pqpp�qryL�WELOCATONSA DNRE�LATEDE SEtdENTSINGALL <br />