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:_.y-_:._..._.__' a.:.>:., :•.. _.._.�. . .:__, _.._. _'�s:_;:_".\ . . :. ... ... . ..... ...ssa�•�.:a'��_fx...w�oan'.. <br />�� , � <br />A��'LICATION FOR '` ' � �,�,�„ <br />Wry«'°"'" CONSTRUCTION 0 <br />everett PERMIT � <br />BUILDINO DEPAR7MENT TO BE COMPLETED IN INK • PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION �BUILDING O MECHANICAL ❑ PLUMBIkO O 910N <br />.. __ usll�00RES! CtIY 21P PHONE . . <br />PIUMB�HOCOHIR�GIOH MuI��DOE55 LIfY IIP PIIONE LICEHSF• <br />CL�l60f WDRN�,� <br />❑ NEW f�J A�DITION ALTERATION ❑ REPAIR ❑ OEMOLIIION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIl01N0 RELOC�TION <br />��l W��ON OF WORK ILOl1 Of M�fE RULS PLU9 L�B�OPI/� J/A <br />/ /l.. � �n � .Cl�� /7/ � . _ _ _ <br />USE Of <br />- , ., <br />ro�ECT �ooness <br />PIUMBIIl6 <br />NO. TYPE OF FI%Tl <br />W11TER ClOSET �TOILEiI <br />BATNTUB <br />UVIITORY IM'�SH BI151NI <br />SHOwER <br />NITCHEN SINN i DISP <br />DISMW�BHER <br />UUNDRY TRAY <br />CLOTMES WRS�ER <br />UAIN1l <br />SINK <br />� ��O�If $E tB�Clt -- <br />/(p <br />— 8�17`ETC � <br />�1i�GN <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORHECT. ALL <br />PROVISION90F LAWSAND OFDINANCESOOVERNINO THISTYPE <br />OF WORK WILL BE COMPlETEO WIiH WNETHER SPECIFIEO HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHOFITV TO VIOLATE OR CANCEL TH�� PROVISIOPIS OF <br />AN V OTHER STATE OR LOCAL LAW REGULATIN�s CONBTFUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SION�TUREOiCONfR�CTORORAUTMOR12E0�0ENT O�IE <br />X Cl --�r-,1;�/%J � - . , ..s-z • <br />M6CHANICAL <br />OR ITEM FEE NO. T'P[ OF EOUIPMENt <br />11/C — �/MN�LO UNITS — H P. <br />REFR16EH�TION UN1T9 — H V. EA. <br />BOILERS — B.T.U.M P. � <br />6A9 FIREO AC. UNITS — BS.U. <br />FOPCED �IR SYSTEM9 —B.T�.. M Fi�. <br />wu� NC�TER9—BT.U. M <br />SUSTOTAL <br />VERMIT <br />TOTALFEE <br />RE�A SEI6�CN <br />l�l �R'LE � ' <br />OCCIIP�NCY GROI <br />R-3 <br />UNIT NEATERS — B.T.U. <br />CLO7HESDRYER9 <br />VENTILATION FAN <br />qANOEHOOD <br />W�TER HEATER <br />WOOD STOVE <br />FIREPLACEINSERT <br />HEAT PUMP <br />OAS PIPINO <br />ExF1All5T FAN <br />1 <br />SIOE SFTB�CK � �LAN I;NECN NUM9E <br />� i ' �� /ao/ <br />V�CANf SIIE FEES <br />11Nli3 <br />iLR110NeCC Br PUtI5C11ECKE00Y I�PPR fOR19511�NLEBY <br />� � �� f� <br />s� � a�� PL� u,�u.fx. <br />� -rN �Q�C�c.�2o� <br />Y!'l( c �^a.Gtt <br />tU! �OTAL <br />KPMIT <br />FEE �3 PECEIPTNO. <br />y83- I 9�1� <br />OUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCMAROE <br />STATEENERGYSURCHARGE <br />PUBLIC WORK3 <br />74�1 <br />TOTAL 7 � <br />PROPERNLOINELOCATONSANDNREBATEDE SEMENT'S�NOALL <br />