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At'PLI�CATION FOR ' <br />'". E".`°,"" �� N ST R U CT I O N <br />CITY OF <br />�verett P�RMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE CQMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />I] PLUMBINCG <br />everett <br />e <br />❑ SIGN <br />OWNER M.111 POORl35 CITY dV nioa , <br />�l�,c�- r d' =�;�,f/ f'o 6��,X -,sy' ,�/r �i<<.-�,, y'8��s-�' <br />nnerur�einnors�ci+en eun aonnrs.. on rin rv�o�ie � � :�I <br />G� 3 �. a'.�. s— <br />GENEFAI CONiRnCiOfl IAAR aD0l1E55 Grv �,( 11P PUONE I ICEIlSE • �. <br />/�/c',� <: rh G / g0 /v� <br />rnec��aHiea� eorunnr.ron ninn noonEss arv cir r��ori[ ueeHse • <br />PWMBINGC01R9nL10R h1AILA0fl�E5S CIIY AP PIIONE IICLNSE• <br />❑J,NE`Ny ❑ �DDITION ❑ ALTERATION ❑ REPAIH ❑ D[MOLITICN ❑ bVO00STOVE/FRPL.�NSERT ❑ BUILOING RELOCATION_ <br />;A1114TIONOFWORHICO$TOFl.IATERPLSPLUSLApOP� ^ �� /� { �fC^� .�I/ <br />� �r �� � G �7 i� � <br />�4CZ-�i� it��(i'�Cl._ �Cl�' � l� <br />^ <br />io�� <br />s9D�— �� <br />aooness <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />WATER CLOSET �TOILET� <br />BATMTUA <br />LAVATORYIWASH BASIN� <br />SMOWER <br />KITCHEN SINK d OISP <br />OISHWASHEfl <br />LAUNDRVTRAV <br />LLOTIiES WASHER <br />11RINAL <br />DRINKING FOUNTAIII <br />FLOOR ORAIN <br />BACKfLOW PREVENTER� <br />ROOF DFAINS — RAINLEA�E <br />SINK �SERVICE — DAR, CTC � <br />� . � ��o� L� <br />ITEM <br />SU9TOTAL <br />PCRMIT <br />}'�TAL FEE <br />�RONTSEI�ALk FEAR SEI�ACH <br />7 0 � �D� ?� � <br />usEzoNE ioTancn <br />12—� �3 Z.S <br />nPE oF COHsr <br />�- P-i <br />SiZE OF pl DG NO OF SiORIES <br />� 1i2� 1 <br />� <br />I HEREBY CERTIFY THAT I HAVE READ HND EXAMWED TliIS AP� <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. A LL <br />PFOVISIONS OF LAW S AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COAIPLETED WITH WHETHEFl SPECIFIED HERE <br />IN OA NOT. THE GRANTING OF A PERMITDOES NOT PRESUME i0 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL. THE PROVISIONS OF <br />ANYOTFIER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR TV1E PERFORMANCE OF CONSTRUCTION. <br />si�r�aTUNeoii:uunitictcnanr,uuionizeoncer�r unre <br />x �1 ,�.,�✓ Z/��'��'� <br />,��,,::��,�5„�«,,,�: „� <br />Atc: HANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />r' AiC — A/HNOLG UNIT$ — H P <br />� REFRIGERATION UNITS —H P EA. <br />� BOILE(iS--B.TUrHP <br />GAS FIRED A C. UNITS — B T U <br />FORCEO AIR SYSTEMS — B T U M EA. <br />WALLIIEATERS—BTU. M <br />UNIT HEATERS — O T U M <br />[VAPORATIVE COOLERS <br />CLOTHES�flvEFS <br />� VENTILATION PAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />MLTAL FIREPLACE 8 CIIIMNEV <br />FIREPIACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%NAUSTFAN <br />f <br />S <br />f " � <br />SIDE SElU4CK PLAN <br />I ♦ <br />/� ,�,�1'. r 6 QS <br />vnr.nur s�a <br />�.v�s ����o <br />no o� nweu.me ue�rts <br />� <br />�a�a occ i.o>o <br />BVPI�f.tllOtl.��l;: HV PIA05CIIECHEDDY PPPP I�.:RISSUAtlCEf1Y' <br />�. _� � � � <br />'L� ' '�� __�, <br />SUBTOTAL <br />PERMIT <br />TOTaLFEE <br />NUMBER <br />ree <br />RECEIPT NO. <br />' FEES VALUA��Un r�c <br />BU�LOING g <br />PWMBING <br />__ / <br />MEGHANICAL d <br />OTIIEF <br />STATE BWLDING SUPCHAPGE <br />S7ATEENEPGYSUPCHARGE —_� <br />— � <br />PUOLIC WORKS <br />TOTAL � <br />PROPCF?1 Y OWPiERS ARE FiESPONStULE �OH DETERMINING ALL <br />PFOPl:Hi1' I.Mf: LOCAIIONSAND 17ELATI. D' ASEMENTS. <br />�� <br />