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APPLICATION FdR <br />'".E",°'"" CONSTRUCTION <br />Gr �. <br />everett PERMIT <br />BUILQ!NG DEPARTMENT <br />289•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING i7'1�ECHANICAL <br />OV14LH M�II �UI1111.:T: CIIV �!1_ �' I <br />i- Illers 13D�- 5��—' �- �1k�a'e-�i v� <br />everell <br />�' <br />❑ PLUMBiN(3 ❑ SICiN <br />m�ura <br />a�-a�_ <br />�P�Ff�tS�ON� M�Il�DI1N[59 b1Y ]IP PNONI <br />GEIIEH�L CONIR�CIOR MMl �DOPEiS G�tv AP �uONE tiCE'�5C • <br />1A�I1 <br />u <br />r��55N V/OA� <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIfi ❑ DEMpLI11UN ❑ WOOOSTOVE/FRPI.INSERT ❑ BUILDING RELOCAiiO�l_ <br />W I U�IiOII Of WOR� �f.OS t fll" IA>11111P1 < 01114 L 1POA1 <br />�9�liWN <br />PNOJELf�pDRE55 l� <br />I�� � ," f /� �' <br />VLUMBING <br />NO. TYPE OF FI%TURE OR <br />WATEP CLOSET (TOILET) <br />BATMTUB <br />UVATOFlY �WASH BASINI <br />SNOWEN <br />KITCMEN SINK 8 OISP <br />DISMW�SHER _ <br />LAUNORV TR�\V <br />CLOTHES WASNEH <br />UFINAL <br />DFINKIN� FOU'JTAIN <br />FLOOfi DRAIN <br />ROOF DRAINS — I <br />SINK ISERVICE — <br />� npNi $FIII�f.Y <br />U :E [U116 <br />nn[ or r.oHs� <br />FEE <br />��� <br />I HEREBY CERTIFY THAT I HAVE REA� AND F%AMINEO TIIIS Af � <br />FLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOFLAWSANDORDINANCESGOVERNING fHISiVPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIi DOES NOT FNESUME TO <br />GIVE AUTHORITV TO VIOLATE OR CANCEI THE PROVI�,IOPlS OF <br />ANV OTFiER STATE OF LOCAL LAW REGULATING CONSIRUCTION <br />OR TF1E PERFORMANCE OF CONSTRUCTION. <br />SIGNPIURE Of GONIR4CTOR OR AUIHORIZEO ACENT 0>fE <br />X <br />MECHANICAL <br />— AiHNDLa UNITS — H.P. <br />RI[:FRSTION LINITS —N P. EA. <br />BOILERS — B.T U iH P <br />GAS FIRED A.C. UNITS — B.T.U. <br />FOi10ED AIH SYSTEMS — B.T.U. <br />WALL MEATERS — B.T.U. <br />UNIT HEATERS — B.T.0 <br />EVqPOqATIVE COOLERS <br />VENTILATION FAN <br />RqNGEHOOD <br />ERS WOOD STOVE <br />� METAL FIREPLACE 6 CHIMNEY <br />FIREPLACEINSERT <br />HEATPUMP <br />6AS PIPINO <br />E%HAUSTFAN <br />SUBtOTAI s <br />PERMIT : <br />TOTALFEE f <br />❑ :FIB�CK Si�E SETBRGi <br />A���A V�f..�NT51If <br />❑YES JNO <br />e�rii�.::.nU!Ia;;; C� �VnSituECNEOBY I��PR FOBISSUANLEBV <br />�UB TOTAL <br />p(q�i;f <br />TOTALiEE <br />VLANI:HECN NUMBEH IF_E <br />BUILOING S <br />PLUMA�NG <br />MECHANICAL <br />OTHEF <br />STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M <br />M <br />RECEIPT NO. <br />PROPF.RT� OWNERS ARE RESPONSIBLE FC1R DElERMININO ALL <br />PROPERTV LINE LOCATIONSAND RELATED EASEMENTS. <br />