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A�PLICATION FOR --' <br />,^.E'.'°."" CONSTRUCTION <br />��r �F <br />everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK • PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMb!NATION �1 BUILDING ❑ MECHANICAL <br />MA1140/0RL55 ��N 6Z���(/ <br />DWNER1 j � \ J SZ?9 �L SCI� ��IQ�LG� /OZ� <br />S�YA wJ NeC�T � <br />. _ __ __'.._._....., Mnii eoo��es�, c � � <br />everetl <br />e <br />❑ PLUMBING ❑ SIGN <br />vHOHE <br />3J���Z�� <br />r�ioNc <br />35� � i' 00 . <br />A/� Rt ( v�c � � - i <br />nR ADO�E55 GIY IIP PIIONE • , <br />� GENEA�LCO iRRC10li 1 )��^ .�`y 'Ylii7 /�Z3z �j I <br />�`-� _„_ . LI„ h.-�- 1�f>� "t�o x(04 � µ�.v Y. ► L�-ea 1.�t51. � 7 �J Lrl L <br />1 � Zlr r��oNE 1.�C[HSE • <br />MEGH�NILnL CONiR�LTOR <br />MFIL AOORESS �'��� <br />PLUMB�NO CONiRnGtOA <br />MPILApDRE55 Gry LP P���NE LICEIBE• <br />Of WOHN <br />NEW ❑ ADDITION ❑ AITERAf10N ❑ AEPAIR ❑ DEMOI.ITION ❑ 1NOO�SiOVE/PRPLINSERT BUILDING RELOGATION <br />JJONO� WOAMILOS� O� F141E�IR� FI/ISI.N9n�9�� <br />V i C.O /L� //� <br />OFSCRiBE W0 K v <br />iv� w��-r-�� kl�r -,,� R ay� <br />� USEOFBUIIDING <br />� Aov��r�� i�aR u,wy � No 66N �.n. <br />,1 LEG�L�ESLRIPiIONO��ROPEPTYISNOWNBELOWO�A1GCRf(UACOPIES <br />.1 �o��u�ocn_—o� <br />j '}��_,tT e F �z �C�tL 1�i4 R� <br />� <br />,; <br />-; <br />r <br />'� PPOJECTAODRE55 <br />�I -�,.�,�- c� N9 i�l _ s. I.0 <br />PLUMBING <br />TYPE OF FII(TURE <br />WATER CLOSET �TOILE7� <br />BATHTUB <br />LAVATORVIWASH BASINI <br />SMOWER <br />KITCHEN S�NK 8 DiSP. <br />DISMWASHEP <br />LAUNDRY TF7AV <br />CLOTMES WASHER <br />UF�NAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />RpOF DRAINS — RAINLEAOE <br />SINK �SERVICE — BAR. ETC � <br />I HEREBY CERTIFY ThIAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION ANU KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />FROVISIONSOF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COA9PLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE ON CANGE'_ THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAI LAW REGULATING GONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNn1UPE�' ONiPnCICR011AUTH0��2E0AGENi DnTE <br />X .I`t.--, /� � � ia_r�sl <br />CIfV OUSINESti <br />MECHANICAL <br />ITEM fEE NO. TVPE OF EOUIPMENT r« <br />A/C — A/MNDLG UNIT$ — M.F <br />REFFIGERATIONUNITS—HP EA. <br />BOILERS—B.TL/MP � ., <br />GAS FIRED A�C. UNITS — BS.U. . <br />FOFCEO �iR SVSTEMS — B TL. M F�� ' <br />WALL HEATEPS — BS U. M , <br />UNITHEATEPS—B.TU. M <br />EVAPORATIVE COOLERS II <br />CLOTHESDRVEFS I <br />VENTILATION FAN <br />qpNGEHOOD <br />WATERMEATER <br />wOOtl S70VE � <br />MET�L FIREPLACE d CHIMNE� <br />FIREPLACEINSERT . <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN _ <br />SUB TOTAL s <br />PERMIT s <br />TOTALFEE s I <br />'PONTSETBACM RERR SEtBACN SIOE SEiB�GN <br />Z � 7• s� ' � <br />JSE20NE LOinRER yACAN SItL <br />C ❑vE5 �O <br />�J <br />fYPEOFC 15L OCCUPnNCYGROU� NOOfOWEL�UNIiS <br />�-i,� M - 1 <br />SI$E OF BlDO NO Of SLORIES Mn[ OCC LOA� <br />AVPLICAIIDN FI <br />V' _ <br />�CNE.NEO BY •PPN (ORISSURNC[ OY <br />/ � � <br />� SUBTOTAL <br />PENMIT s <br />TOTALFEE <br />LANnCH1 /C�N NUMBER FE�� � RECEI/P'�T NO)�� <br />�U Oi-��� V � � <br />FEES VALUATION FEE <br />BUILDING �S l�-� � `✓ <br />PLUMBING � `' `�`� <br />MECHP.NICAL <br />OTHER <br />STATE BUILDING SURCHAAGE J�J. <br />STATE ENERGY SURCI�ARG[ <br />PUBLIC W�RKS � <br />TOTAL <br />cq5�sc <br />PfiOPERTY LOINE LOCATONS AND RELA7ED E SEMENTISING ALL <br />_ _ . . ' :: .. ... <br />. _. _. . .....; .. . . . ,.. <br />.. . " .' . .. � :.:.� �' . . . . ' . . _ <br />