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•n. ew�w«n <br />em or <br />everett <br />BUILDINO DEPARTMENT <br />259•8810 <br />,,PPLI�CA,TION FOi. <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />titNEPstWNin�G10R M�R>OURE55 <br />o� (�ruvrt,q rnNiH�Unq �.NIL �f1pRE55 <br />ftLAS U.w't.i._ Re�L��! 8��+.�4 <br />cin <br />rN t ,�.9'1 tz <br />�s 11 � k <br />I ��Crq.lcf . <br />TI�VQ/ / <br />❑���;EWy ❑ ADUITIC�N ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVElFRFL.INSEPT ❑ BUILDING NELOC•��I(�N_ <br />v�iu+noe nr wonv �r.o.t or re•�u,�ni �; r�us i.nnon� <br />OC <br />PLUMBIN6 <br />' NO. TYVE OF FIXTU <br />W�TER CIOSET ;TOILETI <br />B�iHTUB <br />� UVATOFV �WASH BASINI <br />SHOWER <br />. NITCMEN SINK 8 O�SP <br />UPINAL <br />ORINNINQ FOUNTAIN <br />FLOOR DRA�N <br />BACKFLOW PREVENTE�S <br />ROOF DRAINS — ApltlLEADE <br />SINK �SERVICE — BAR, ETC � <br />� Pt)qt SE �OACn <br />Or <br />tiVE U� AI DG <br />ufin.e��04af:f, 9v <br />� <br />BEIOW <br />IiEM <br />SUlTOTAL <br />PE(1MIT <br />TUTAI FEE <br />R�MltiF�BPCM <br />LOI PI1FP <br />O�:nR'RIICV GROUP <br />CIIECNE� B� <br />I fiEREBY I:ERTIFY THAT I HAVE READ AND EXAMINED THIS Af'� <br />PLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCESGOVEFNIN(3 THIS TVPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTIhG OF A PERMI7 DOES NOi PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOP!¢ OF <br />ANY OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTiON <br />OR THE PERFORMANCE OF CONSTFUCTION. <br />SI�NAIURE OF CONiFACTOH OA AU7NORIZED AGENT D>7E <br />X G'l/���».- .��.�. �— sz- 98'_ <br />�PPLIf.�N i'S CITY BUSINESS .ICkNSE N <br />MECHANICAL <br />FEE NO. T/PE OF EOUIPME <br />A/C — A/MNDL6 UNITS — M.P. <br />NEFFIGEPATION UNITS — N.P. EA. <br />BOILERS — B.T.U./H P. <br />GAS FIRED A.C. UNITS — O.T.U. <br />FORCED AIR SYSTEMS — B.T.U. <br />WALL HEATEfiS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPOFATIVE COOLEP5 <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEMO00 <br />WATER MEATER <br />WOOOSTOVE <br />METAL FIREPUCE 8 CHIMNE� <br />FIREPIACE INSERT <br />HEAT PUMP <br />GAS PIPIN(i <br />E%HAUSTFAN <br />� <br />f <br />f <br />SiOE SETB�CN <br />V�CAflt S�IE <br />UYES ONO <br />Nn OLOWFLLINGUNIIS <br />Mex occ wno <br />R1`FR fOp �SSUANGE BV <br />- SUs TOTIIL <br />P[RYIT <br />TOTALfEE <br />VIAN CNECK NUMBE{7 � FEE <br />I� <br />HECEIPi Np. <br />rcca — <br />AUILDING 5 <br />PLUMAING <br />MECHANICAL <br />OTHER <br />STATE BUI�DING SUHCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMININC ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASENENTS. <br />