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m� r:wro•«� <br />� cm os <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />i-�PPLICATiON F01�.-� <br />CONSTRUCTION <br />PERMIT' <br />TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />everen <br />e <br />❑ S!GN <br />PLUMBINGCONTR�CTOR M�iLqD�AESS CIIY 2iP VNONE UCENSE� <br />CU55 OF WORN <br />� NEW ❑ ADDITIOlJ ❑ IiLTERATION ❑ REPAIR ❑ DEMOLI710N ❑ WOOD5T0'JE/FRPL.INSERT ❑ BUILDING RELOCATION <br />... �..�n.....o•nu..�natner.ui[Ri�L5PW5l�AOR1 <br />�iVQ � r�s <br />L01L BLOLK�.. <br />L'h2Nl <br />IOJECTAODRE55 <br />33o s -rqy� S� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR I' <br />WqTER CLOSET ITOILE7� _ __ <br />BATHTUB <br />l,qy/1TORV �WASM BASIN� <br />SHOWER <br />KITCHEN SINK �. <br />DISMWASHER <br />- LAUNDRYTAAY <br />CLOTHES WASMER <br />URINAL <br />DRINKING F4UNTAIN <br />SINK <br />VRONTSEIB�GN <br />/� I <br />�SEZ�E Z <br />�` r <br />TYPE OF'�C�],j9t. <br />.L� -N <br />� nNIryLCnui <br />- Bna. ETC.1 <br />PERMIT <br />TOTAL FCE <br />RERR SEIB�CR <br />_ / <br />� OZ� <br />OCCUPpRNLYGROUP <br />/i - .� <br />1�0 OF STORIES <br />FOUR COViESI <br />f <br />f <br />S <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATIONAND KNOW THE SAME TO BETRUE AND CORF:�CT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING 1 Hi5 TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIt:� HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCFL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTHUCTiO�a <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />$IGNATURE OF CONTRACTOR ON AUiHOFIZED AGENT UATE <br />/� J � � IY / � / � � � .. . rir <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPI <br />Q�j A/C - A/HNOLG UNITS - H.P. <br />5 REFRIGEFATION UN�TS - H.P. F <br />BOILGFS - B.T.U./H.P. <br />GAS FIpED A.C. UNITS - B.T.U. <br />` FORCED AIR SYSI'EMS - B.T.U. <br />� WAILHEATERS-B.T.U. <br />UNIT HEATERS - B.T.U. <br />� EVAPOPA7IVECOOIERS <br />f.LOTHES DRYERS <br />� VENTILATION FAN <br />qANGEHOOD <br />WATER MEATER <br />wO00STOVE <br />METAI FIREPUCE ! CHIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPINO <br />ExHAUSTFAN <br />��' � sl <br />VACANT $iTE <br />�IES ONO <br />NO. OF UWF.LLING UNI <br />i <br />MR%. OCC. LOAU <br />N.�3- <br />]NeCt BV PLGNSCIIEGkE08Y APPR.FORISSWNCE9Y <br />�� � � <br />ree <br />M EA. <br />M <br />M <br />SUBTOTAL <br />IKHMIT <br />�— TOTALFEE � <br />P�ANCHEC UMBER IFEE �y RECEIPTNO. <br />g $'%IRSO� ; 1 g�/ �" � S� <br />BUILDING s 'J(��~ . <br />� PWA�BING �/ �i I <br />MECHANICAL � � <br />I O7HER � <br />STATE BUILDING SURCHARGE 3 ,j ��I <br />STATEENERGYSURCHARGE 5 �, <br />PUBLICINORKS 7i % <br />TOTAL iO <br />PROPERTYOWNERSAFERESPONSIBLEFORDETERMININ(3ALL �' <br />PROPERN LINE LOCATIONS AND FELATED EASEMENTS. � <br />I <br />_ ... ....... . ... ...._... . ..,_.•rr�r;':i�s-..;n.',��r,:v�.. <br />.:.—'GJ-�" �. . . ....._.. . . u•.:;:;72::. <br />