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�' � � <br /> r�PPLIC�ATION FOt�► everett <br /> '"'E""°'"" �ONSTRUCTION <br /> cin oc � <br /> �verett PE RM IT <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK- PLEASE PRINT I <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O IVIECHANICAL ❑ PLUMBING ❑ SIGN � <br /> O � r MAII�D�RE55 Girv ZI PNON[ I <br /> � , � ��n �`ll. �a��� 1=��,��� I���=� ,�Sg-���j, <br /> ARCNI(EGLOROESIGNER MAILOODRE55 C�TV 210 PNpryE � <br /> GENEAAL CONiflAC10N MRIL PpORES$ CIIY ZIP PI�ONE IILEN$E• <br /> MECHANICAL LONiRACTOq MAIL AOORE55 Ci1V IiP PIIONE LICENSE• <br /> � �i� l'1� l(� � <br /> FLUMBINGLONIR4CIOA MAILADDRES$ GTY ZIP PIIONF LILENSE• <br /> CLA55Oi WOAK <br /> ❑ NEW ❑ ADGITION ❑ AL7ERATION ❑ REPAIR ❑ DF.MOUTION � WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAf10M <br /> VALU4i10110�\Yri4F�C051 Oi MR1ERu�5�LUS Laf30Ri <br /> � OfSCA�dE WOAH � ' I <br /> n ' � �' �' ; <br /> U EOFOUiLDi`�G I HER[BY CERTIFY THAT I HAVE READ AMD EXAMINED TIiIS AP- <br /> �� � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALI I, <br /> IEGRL0F5CRIP11pNOFPROPERiVI5110WNBELOWORATiAGMFOURCO��E51 pROVISION50FLAW5ANDORDINANCCSGOVERNINGTHISTYPE <br /> OF WORK WILL EE COMPLETED WITH WHETHERSPECIFIED HFRE� <br /> �o�—oiocr`_ov IN OR NOT.THE GRAYTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CCNSTRUCTION I <br /> OR THE PERFORMANCE OF CONSTRUCTION. . � <br /> SIGNAIUFE OF CONiR4CTOR OR AUiNOPIZED FGENT DATE I <br /> X ! /D-7- �7 I <br /> PqOJECTnODRE55 r1PPlICR . CItYBU51NE55�ICEN5EN0 <br /> �r�V � f�'1 " �' _ �� <br /> , PLUMBING MECHANICAL <br /> ' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOIIIPMF.NT FEE � <br /> WATER CLOSET�TOILET) A/C—A/HNDLG LINITS—HP. <br /> BATHTUB REFflIGERATION Uh1TS—H P.EA. . <br /> �AVATORV(WASH BASIN� 001LER5—B.T.0/H.P ' <br /> SHOWEF GAS FIREO A.C.UNITS—8 T.U. ��. <br /> KITCHEN SINK 8 DISP. FORCED Alq SYSTEMS—B T.U. M EA. � <br /> � OISHWASHER WAILHEATEFS—B,T.U. M ' <br /> LAUNOFY TRAY UNIT HEATERS—BS.U. M �' <br /> CIOTHES WASHER EVAPORATIVECOOlERS '�, <br /> UMINAI CLOTNESDRVEflS �I <br /> � DRINKING FOUNTAV� VENTIIATION FAN i <br /> FLOOR ORAIN RANGE HOOD _ � <br /> � BACNFLOW PREVENTERS WATER HEATER � <br /> ROOF DFAIN$—RAINLEA�EFS WOOD STOVE <br /> . SINY,�SERVICE—OAR.ETCJ METAL FIREPLACE d CHIMNEY <br /> FIREPIACE INSERT <br /> HEAT PUMP <br /> � GAS PIPING ' <br /> ' E%HAUSTFAN . <br /> / <br /> � SUBTOTAL S SUBTOTAL . <br /> PERMIT S PERMIT <br /> TOTALFEE f TOTALFEE <br /> � ruoNi SEtOaCk �EAA SELBnGK SIOE SETBnCH PIAN CHECK NUMBER FEE RECEIPT NO. <br /> use zoNe LOi AqEA yqCI.NT SRE FEES VALUATION FEE <br /> ❑YES ONO S <br /> BUILDING <br /> �l'PEOFCONST OCWPANCYGPOUP ��OOFDWFLLINGUNIiS <br /> PLUMOWG <br /> SIZE Oi BIOG Np 0�SLORiES MR% OLG LOAD MECHANICAL � <br /> OTHER <br /> �-iRE SPRINKLERS REOl11RED ❑ YES ❑ NO STA7E 6UILOING Sl1RCHARGE <br /> STATE ENERG�SUPCHAtiGE <br /> ;,rP�IC0.110N PCC B� PLANSCNECNEO BV APOq fOR ISSU�NGE BY <br /> PUBLIC WORKS <br /> TOTAL � <br /> PF70PERTY OWN[RS ARE RESPONSIBLE FOR DETERMINING ALL <br /> P90PERTY LINE LOCATIONS AND RELATED EASEMENTS. . <br />