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� <br /> ',-,PPLICATION F01.- ' ���,�„ <br /> ;: '".E"'°'"" CONSTRUCTION <br /> ��n oF e <br /> �� everett PERM� T <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> .h ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING [�MECHANICAL ❑ PWMBING ❑ SIGN <br /> � OWNEH M�II��OR[5$ CIIY IiP �MOHE <br /> s' � �� , �„� ��U C/�,�� io�F �c� /� �N/�„� � ���,at� �fz�� <br /> ���. �NGHI}EL�ORGF51(iNER MRIIADI)NfSA 6�IV lll` PiION[ <br />.P+�' <br /> GENEH�ICONIRRCIOP MnilnppliF55 C�1v LP �'��ON[ LiCENSE� <br />'.;< CroNinl 1-��mes �1 13 SE f� mA�t wnv �'0 353 6500 <br />� ' MECH�NiUI CONiP�CII�q M�R ADORESS 6ilv ER' P��ONE LLENSE <br /> � L'Lec+}2;c CuRNRCE�'N�� /`�L13 tk�ee �ksR�1 Sa��I,,,T,s� F�zsa 5�7oa.f �'L��TIZz�l3� <br />�'-'-, <br /> PWM91N�i_]NiR4CfOR MRII AppR[55 (:IIY 1i1' PUONE UCENSE• <br />�' .. . CU$$O!WORM <br /> ���'�� � NEW ❑ �D�IfION ❑ ALTERAIION ❑ RC-PAIR ❑ UFMnLIIIUN ❑ WU(1DSIOVE;fNPL.INS[RI ❑ AUILUWG RELOCFIION_ <br /> �IUALONOfWpll„�COSIO�MAICRIPL):PUI!:I.AB�llb _ . <br /> j INS�f'�4C� �-�P{��I.,v� f� f�} Ir' l'o,U ol �`' �H� �/ .f.i <br />' j oestnieEwonK �—� <br />,• ; <br />{�� - � useovawio1ir+c � ��� I HEREBY CERTIFY THAT I HAVE READ AND ERAMINED THIS AP- <br />��;:;;�� � e,NY-f-L CL/.tll�< PLICAT�ONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEG�LDESCRIPI10�10fPAOP[RiY15110WNBELOWONRIIAC11/OU�CO�IF.Si pqpVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> ;".r,�. ' OFWORKWILLBECOMPLETEQbYI7HWHETHERSPECIFIEDHERE <br /> ";.� � io�—o�ocK—ov INOFNOT. THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TU VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL lAW REGULATING CONSTfiUCTION <br /> yi, <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> ,a�.'�'` _ SIGN41U�E0!'COHIII�CLOROpf�U1110�IZF.OnG[Ni �nTF. <br /> 1^�i .� � <br /> i 8 <br /> - � X Ct�.ti��� � �'21 8 <br /> 4�" ' PHOJECIAODRESS /O A�'�`IIfANfSf.11�PU`dHPSti1�Cf.b51:N0 <br /> F..,. ? . 1�h �1�1� .S[_ � V <br />;, <br />�`� � MECHANICAL <br /> PIUMBING <br />��'� S NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> l:. <br />�r { WATERCLOSET�TOILET) AIC—AiHNOLCUNITS—H.P <br /> '' BATMTUB HEFqIGERATION UNITS—H P.EA. <br /> ' LAVATORVIWASMBASIN) BOILERS—B.T.UMP <br />- 3 SHOWER GAS FIRED A C.UNITS—BSL. <br />�1'.. FORCEO AiF7 SYSTEMS—BSL.�]5 M EA. <br /> � J; KITCHEN SINK d�ISP <br /> DISMWASMER WALLNEA7E175—B.T,U. M ' � <br />'���� LAUNDFV TRAV UNIT HEATERS—BSL, M <br />��"' � CLOTHES WASNER EVAPORATIVE COOLERS <br /> URINAL CLOT��ES Ofi�ERS <br /> ORINNING FOUNTAIN VENTILATION FAN <br /> �- fLOORORAIN RANGEHOOD <br /> � BACKFLOW PHEVENTERS WATERFIEATER I <br /> ROOF DRAINS—RA�NLEADERS WOOD STOVE <br /> S�NK�SERVICE—BAR.ETC.� METAL FIFEPLACE d CHIMNEV <br /> FIREPLACEINSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> SUBTOTAL S SUBTOTAL U <br /> PERMIT S PEpM1T <br /> TOTAL FEE i TOTAL FEE C� � <br /> �RONISEipnf,n �IEnRSEI64CN 5m[setencn ✓LANCMECNNUMBER FEE RECEIPTNO. <br /> usetont �O�A���A yqCat115�IF FEES VALUATION FEE <br /> ilvF.S I INO <br /> BUILOING 5 <br /> IYPE OF CONSf OCCIIPRNCY 811AUP NO Of DWFLIINfi UNILS <br /> PLUMBING <br /> SILE o�Bloc Nn or StonlEs Mnz oCC tOAD MECf/ANICAL {/ <br /> OTHEF7 <br /> FIRE SPRINKLERS REOUIRED O VES O NO STATE BUILDiNG SURCNARGE <br /> STATEENERGYSURCHAFGE <br /> nPPI1f.AliONnCCN� PI.fNSCUEGNEOaY AfvPf011i5SUANGf:flY PUBUCWOfiKS I <br /> � �J� . TOTAI . I <br /> ,V' ' <br /> PROPF.RTV OWNERS ARE FiESPON5IBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. I, <br /> I <br /> 4 <br />