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f+PPLlCATION FO�.. <br />`".E"`°""° CUNSTRUCT�ION <br />c�n ov <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN !NK • PLEASE PRINT <br />❑ DEM6_ITION ❑ COMBINATION �BUILDING O MECHANICAL <br />J-W-yN+ER / Mall AppHE55 Cltt ilP <br />/i�i'Y%Ii%� tC) �1�.�.��� �%/� �: i`�CSI.J l-7'L`% �"� <br />�bf. iTFf.t ON OFSIGNEB MAII >OpRL55 CRV ZIP <br />O PLUMBING <br />P110NE <br />%Y � �> i .� <br />❑ SIGN <br />_ !. S� <br />GENERAIGONTRALtOP ' MAII abDRE55 f.rtY ZiP nupNE �ICENSE+ <br />T�T/T CJ�! �/��G /�-- . <br />MECMRNIGL CONTHRCiO!{ MPIL ApOflE55 CIfY ZIP PHONE �ILENSE • <br />-wmon..aw......�..� ..._.. _......___ _... <br />/ � <br />:USS OP WORM <br />❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITICIN ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />�AIU�T10N OF WOfiK�LOST OF MafCFIAI.� PLIIS I.PBOfii / <br />fr�.�/ �G�]'b g i _ - __a / II ('..f� >'j . <br />WOqK <br />IEGRI pESGRIPTION Os Pn <br />101�B�OC� <br />`= t !'-1 ` =; � ='� 1 �� <br />PLUMBING <br />NO. TYPE OF FIXTURE O <br />WATER CLOSET �TOILET� <br />BATHTUB <br />LAVATORVIWASH BASIN� <br />SHOWER <br />NITCHEN SINK 6 DISP. <br />DISHWASHEH <br />UUNDRV TRFY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINIEA�ERS <br />SINK �SERVILE — BAR, ETCJ <br />IRONiSETBaCn <br />�� <br />n-� <br />iYP[ OF CONST <br />Q N <br />SiZ[ OF Bl� <br />; 5�r� �Ao <br />�.� ; <br />FOUR COPIE51 <br />7- � <br />I HEREBY CERTIFY THAT 1 HAVE READ AtJD EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESI�ME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNFTURE OF CON7BACTGP OF AUTHOPoZED AGENi []ATE <br />X i1.0 J�/�l/_ � 8/.� /� <br />MECHANICAL <br />v <br />FEE NO. I TVPE OF EOUIPMENT <br />A/C — A/HN�LG UNITS — H P. <br />NEFRIGERATIONUNITS—HP EA. <br />BOILERS — BSL /M P. <br />GAS FIRED A C. UNITS — B.T.U. <br />FORCED AIR SVSTEMS — B TL. M <br />WALLMEATERS—B.T.U. M <br />UNff HEATERS — B.T.U. M <br />EVAPORATIVE COOLEFS <br />CLOTHESORYERS <br />VENTILATION FAN <br />fiANGE HOOD <br />WATER MEATEH <br />WO00 STOVE <br />METAL FIREPLACE 8 CNIMNEV <br />FIREPLACEINSERT <br />MEAT PUMP <br />GAS PIPING <br />SUBTOTAL S <br />PERMIT f <br />TOTALFEE f <br />REAfl SEniB�CN SIpESETBnCK <br />K � � <br />LOiNPEA ypCPN) �fE <br />UYE5��.0 <br />OCCUPANCYGROUP IlOOFOWFLLINGUNItS <br />.l�-/ <br />Ho or sroaies <br />l <br />MPX O^L/C l(1 <br />/�� <br />PtiCRiION nCL BY PlANSCNEGNED BY ' APPR POR ISSUANCE <br />�� �- L�G <br />I SUB TOTAL <br />� VCRMIT <br />TOTAIFEE <br />PLAN CME .K NUMBEH FEE ' RECEIPT NO. <br />1 � i ,°� � � "' il � 1__ , r,�,-,..t � , <br />FEES VALUATION FEE <br />BUILDING 5 S <br />PIUMBINCi <br />MEGHANICAL <br />OTHER <br />STATE DUILDING SURCMARGE 3 <br />STATEENERGVSURCMARGE <br />PUBLIC WORNS <br />TOTAL z SY <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />