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,�,E„ro�, APPLICATION FOR � � <br /> �,ry oi eve�rn <br /> everett �ONSTRUCTION ��n �� <br /> PERMIT �a57 -5 3s ; e <br /> BUILDING DEPARTMENT <br /> 259•eB10 TO BE COMPLETED IN INK • PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUIL�ING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> owacn �u�i .nnmss u�v n�� ano.0 <br /> ( .�L, l .�� l',a/�� ,4 ��ilr i - [ tl. {�, - r � l � l ���� N c' . <br /> �C t[C ) 01 Nf � ppNISS iitV J�P PHpNL <br /> i%�i�..0 <br /> (itNER�IGONiR�CIOA M�il 4lDBE55 C��v 1�1� pnqNf <br /> L" ll(.l.1151 • <br /> 5��/ <br /> MFfnlNif,��[pN�AA(.1l�q MMl �DOAfSS qII� !IP PNONt �IClN51 • <br /> 13�=t4 �.,t?'�rtl�-,1 y.y= <br /> PIUMfl�NqCON�R�UDN MuI�D[)Pk55 Cilr /iV PIIONC tiLfl141 • <br /> CL�5501 WpRF _ <br /> ❑ NEW ❑ ADCITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> wiu�nw�or woa.�aoti�o� rAnrcaiH ti r�us i Hna� _' <br /> �L'- �5 %�/=� <br /> pfSCRiBf WON• � <br /> ��)4S �k� ) �- ('t ♦ .� . �'r[�� pA ' 3rf� �( � � 3 I/ T [ �/S� G • J �cc � <br /> usr ar awioiNc <br /> 1 HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS AP� <br /> PUCATION AND KNOW THE SAME 70 BE TRUE ANDCORFECT.ALL <br /> ifn•io[scA�Pno�+o�anoccnrrisNowNecwwonen•curounr.awes� pppVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE� <br /> 1O'—B1OC�O` � IN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITV 10 VIOLATE OR CANCEL THE PqOV1510NS O� <br /> ANV OTHER STATE OR LOCAI LAW qEGULATINGCONSTRUCiION <br /> OR THE PERFORMANCE OF CONSTFUCTION <br /> si,a<wr�rorcoa�aerirqonnun�orazrnnoir�r i,,,r <br /> X �/ � . <br /> .��el �laz <br /> npoi[W�Dnness •nri���uir�.i.n.mi��ni ss i�r�Hti[ a.� <br /> tN S N� <br /> PLU SINO MECHANICAL <br /> NO. TYPE OF FIIRUPF OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEN CLOSET�TOILET� q�C—A�HNOLG UNITS—H P <br /> B�TMTUB qEFqIGER�TION IINiTS—11 P EA <br /> UVI1T017Y�WASM 011SIN1 BOILER$—B T U�M P <br /> $HpWER GaSFIRED�C UNITS-9TU <br /> KIiCHEN SINN 6 OiSP FORCED AIR SYSTEMS—B T U M EA <br /> OISHWASHER WALL 11EATEFS—B T U M <br /> LAUNORV TRAY UNIT HEATER$—B T U M <br /> CLOTHES WASHER EVAPORATIVECOOLERS <br /> UAINAL CLOTMESOFYERS <br /> OaINNING FOUNTAIN VENTILATION FRN <br /> FLOOF OAMN R�NGE HOOD <br /> BACKFLOW PREVEN7ER5 WATER HEATER <br /> ROOF DR�INS—R�WIEADEAS WO00 STOVE <br /> SINN�SERVICE —B�A.ETC I METAL FIPEPUCE 6 CMIMNEY <br /> FIREPLACEINSERT <br /> MEATPUMP <br /> GAS PIPING <br /> EYIdUST FPN <br /> {Us TOT�L t 9Us TOTAL <br /> PERMIT i PfRMIT <br /> TOTAL R[ f TOTAI F[[ <br /> �nuN�5F�B�ce nE�a sF�B�ch � SioE 5[iB�Cn RAN CMECN NIJMBER FEE RECEIVT NO <br /> io ' s ��z�3� ��� I�o�q �I <br /> ���E��/���t ior ene• �.c�rrt sm FEES VALUATION FEE <br /> �� • ts�� f!vE5 .NO � tl <br /> �t <br /> �VPf Oi L 5l Df,COF�NCVf.ROUC NO Of OWELLiNGUhi15 BUILDMCa S� Iu <br /> 'A I <br /> � �N /v/ -� � PLUMBING <br /> Srlf Of tli I�G qU Ui SfORrF9 M�e OCG i0�0 <br /> 3�I �F � �/� MECMANICAI <br /> OTHERSZVS ���% 5 <br /> FIFE SPRI�NLERS REOUIRED ❑ VES NO <br /> STATE BWLDiNG SUPCMARGE <br /> STATEENERG�SUPCH�RGE <br /> °�� ��'���� i�' �'l4N$CMECMEOBV IOPpiORlfiSII�NC[ Nv <br /> /� /� PUBUC WOHKS <br /> � TOTAL � <br /> PROPERTV OWNERS FFE RESPONSIBLE FOR DETERAfININO ALl <br /> PROPERTV l.INE LOCATIONS AND RELATED EASEMENTS. <br />