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,�.E„ro„.� p►PPLICATION fOR <br /> ��r o. ���,�n <br /> everett CON ERMITTION e <br /> BIiILDING DEPARTMENT <br /> 259•BB�O TO BE COMPLETED IN INK - PLEASE PRINT I <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING Cl MECHANICAL G PLUMBING ❑ SIGN <br /> owrv�_n �un eoontss c,e� ri� <br /> /� w�ovi � — <br /> � !-A �-'!= 'J . -' -' �' j��'.5 /I� �/;�'� �, / <br /> < <� � � � M.�� ,�,o�,t,s ,,. —� „ r r I F.] n:, 3 5"S_ ��/ ;•� <br />, . �.,,��� <br /> lilN[R111-0�P�i�LLM MLiI aDfIRF55 <br /> prv 1��• rriqryf �IClNsf • <br /> U�e'��v�1 <br /> Mrnua�ivi cnN�a•crnq r,��u ecnnEss a�r rin m�nae <br /> IICINGF • <br /> OWMfl�N�ICONlR�CtJR M41 �DDNI55 <br /> �rv In ruOqr <br /> i�cu�tir . <br /> I C1�55P� WOR� . <br /> ❑ NEW �ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOL�TION ❑ WOODSTOVFrFRPl.INSEiiT ❑ BUILDING RELOCATIpN <br /> V�lll�!'�ilf WiIPn�('.nS1�11 RI�I[QIqL51�111$1�P7N. _ <br /> ✓ ;,�� pJJ <br /> DISC OLWJ <br /> L� /� i� �_ <br /> /_ (� l � n �' � <br /> UVF Ov flWlf1MG <br /> �• �, � r� } T � HEFHBY CERiIFY THAT I HAVE READ AND E%AMINED TIiIS AR <br />� �rr..inrscn�nnowo�c ovcnn SnOWNflCLOWOu��1�L�.�pVqfpp�l5i PLICATIONANOKNOWTHESAMETOBETRUEANDCORREC7.ALL <br /> PROVISIONS OF LAWS ANO ORDINANCESGOVERNING TFIIS TVP[ <br />! ,���fli�,�,�_��r, ,— ' �? OFWORKWILLBECOMPLEIEDWIiHWHETHERSPECIFiEDHERE� <br />� IN OF NOT THE GRAN7ING OF A PERMIT DOES NO?PRESUME TO <br /> GIVE AUTHORITV TO VIOLATE OR CANCEI THE PROVISIONS OF <br />, ANV OTHER S7ATE OR LOCAL lAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> &uNn1uRLOrCONrqa�tOnpqqulnOni]tp4(1tNt pntL <br /> YHn.IFC11ppRE55 �� �� � <br /> � ��PCi �N "bh BUSiNFS� 5� yr� � <br /> C' � ( <br /> 1 <br /> � <br />� PLUMBIN(S MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIVMENT FEE <br /> I W�TER CLOSET�TOI�Et� qrC —AMNOLG UNItS—H P <br />� O�TMTUB REFRIGERnTION UNITS—N P EA <br /> ILAVATORY qVASM B�SINI POILERS—81 U�H P <br /> $HOWER GAS F�PED A C UNIT$—B T U <br /> NI7CHEN SINN 8 OtSP FOFCEO nlii SYS7EMS—B T U M FA <br /> DISMWASHER Wp�LHEATERS—BTU M <br /> I . LAUN:`RV TRAV UNI7 NEATERS—B T U M <br /> CIOiHES WnSHER EVAPOFnTIVECOOLEPS <br /> I URINFL <br /> CLOTHESDNYERS <br /> DRINKING FOUNTAIN VENTILATION FAN <br />� F�00�ORAIN RANGE MOOD <br />, BACKFLOW PHEVENTEf75 WA7ER HEATER <br /> FOOF OF�INS—RAINLEAOEAS WOOD STOVE <br />� SINK ISERVICE —B�R.ETC 1 METAL fIPEPUCE A CHIMNEY <br /> FIPE�LACEINSEFT <br /> 11EAT PUMP <br /> CAS PIPINC <br />� <br /> E%MAUSTFAN <br /> SUSTOiAL { <br /> SUB TOTAL <br />�� PEflMIi f P[RYIT <br /> TO1ALFfE 3 TOT�LfEE <br /> �m.�y�s�r��� • �� aE�RSErB�Cn <br /> S�oE SEIB�Cn nAN� ECN NUMBE� FEE PECEIPT NO <br />� ��� 7 ���- a�� r�� �� �� <br /> �IGFIqNC lO1�qEA <br /> v.c.r��src FEES VALUATION FEE <br /> .t.,�o z <br /> 'vut o� ra5� ocru�r�/nJcrr.qpuc po oi Pwn.�e�Guruis BUILf71NG $ ��� <br />� i- �� �✓/ `I � PLUMBING <br />� b,:f n� [LRi ��' ' n0 orzrORiEs rA�. oCL ln�n <br /> 'QQ � � y'/ MECMANICAL <br /> �7 <br />� O1HER <br /> fIRE SPRINRLERS FEOUIRED ❑ VES �NO <br />� r STATE 6UILDING SURCMARGE <br /> SiATE ENERGY Sl1FCNARGE <br />� u��'ii,.eiio4.i� e. P�a�6V�EcnFOPv �nPu rauisSU�4(.1 e. <br /> ���� PUOLIC WORKS <br /> �/'� _—__ �� ' I � �G—__— TOTAL — <br /> �� I <br /> -L <br /> PRJP[RTV OWNE�$ARF RFSPi)NSIAL[fOp OFTERMINING ALL <br /> PROPERTv L W E LOCATIONS AND RRATF.O IIASEMENTS <br />