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"'.";PPLiCA�T�ON fc�:� <br />'"'`"'°"'° CONSTRUCTION <br />��rv o. <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COIVIPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL <br />i�2! S �17 A�NNoti► �„�, ,.����.: - �,,. ::P <br />Z�26 S�/m�� � i G_vf.�E�_22� <br />m <br />� <br />� <br />❑ PLUMBINC� ❑ SIGN <br />����,� <br />z<s8 �33z.G <br />,,,.�,,, <br />L1Y(P\lC�l`11�1111��1i AI�iIAf`I111C�5 C�tY lll� Irl�f)NF LII:tN�[• <br />J�R�- u�ES � co�v�� ��_� _�� �y ' s 9B�y ����y�� �,�c�v£c�oiy�n <br />vicu��a�a, C; 4n�eCq�q �yy e0nntgy f,nr 1iP vNOyE li[[q5f. <br />nlUA1A1N�3l.l�Yi1l�CllA �IAl1In(1R�SG fllV ZI� I�IILIII[ 11�CN$L• <br />Gl�$$Of WONrt <br />❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DC-MOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RELOCATION <br />v�t U�hON O� N'P�:� �C09 Ci puttnuL51't USI+Ppni <br />SCA@l <br />USI.Oi BWi. <br />ICG�I [lE5Cql1`IIUN u- v��Vr <br />ioi—e�ocn__._o� <br />�OJEC*�DDHE55 <br />�(� ��� W�/Yl l <br />-- . . <br />rLUMStNG <br />NO. T'PE OF FlIfTURE OI <br />W�TER CLOSET �TOIIET� <br />BATNTUB <br />LAV�TONY IWASN B�SIN� <br />SNOWER <br />KITCMEN SINK 8 DiSP <br />DISMW�SNER <br />UVNORY TRI1Y <br />CLOTNES w/.SME� <br />UA�NA� <br />DRINRING FOUNTAIN <br />FLOOR OAAIN <br />BACKP.OW PREVENTERS <br />RpOF DRRINS — RAINLEAOERS <br />SINIc iSERJI�E — BAA. ETC 1� <br />sue rors� <br />PERMIT <br />TOTAL FEE <br />uE�R SE�O�CK <br />NC Of r pN9 <br />O� 0� OG <br />�i �C<PO'. et�.t. Pr <br />�_�(I <br />`� VTV <br />an�CN r <br />ii <br />� <br />sme <br />V�CPNT $IiE <br />❑1E5 :1N0 <br />Ov <br />I f1ER[BY CERTIFY TNAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERN�NG THISIYPE <br />OF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE- <br />IN OR NOT. THE GfiANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION <br />OR THE P[RPORMANCE OF CONSTRUCTION. II <br />SIGN4tU�E2�CONTRACTCROgFUTHOA�AGEHT pnTE ���Z�✓� <br />V <br />MECHANICAL <br />TYPE OF EOUIP'A! <br />rl/C — ArHNOLu' 1 "!'T9 — <br />RFFR�GEPNTIO'J UNITS — M P EA <br />BOILERS — BJ U /H P <br />GASFIREO>S: UNITS—BT.LL <br />PORCEO AfA SYSTEM$ — B.T U. <br />WALL MERTERS — B.T U. <br />UNIT MEATLNS — 8 T U <br />EVAPORATIVE COO�ERS <br />CLOTMES ORVERS <br />VENTILATION PAN <br />RANGENOOD <br />WATER HEATER <br />WOODSTOVE <br />METAI FIFEPLACE i C�iIMNEV <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />{q,AN CHECK NUMBER <br />6UlTOtAL <br />xnwir <br />TOT11L FEE <br />�FEE <br />Bl11LDING S <br />PLUMBING <br />MECMANICAL <br />GfHE(i <br />STATE BUILDING SURCHARGE <br />$TP'cENERGYSURCNARGE <br />PU�LIC WORKS <br />TOTAL <br />M <br />M <br />M <br />RECEIPT NO. <br />PROPERTV L�INE L CATIONS PND RELATED E SEMENTISING ALL <br />