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^C� I�ATION fn�. ��-C��S <br /> rn.c..,p,»n • • <br /> �,ro. �° R�i TIC� ,V ,�,� � <br /> everett � <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED !N �NK • P.[ i' �c PRINT 1��I l'� ':�> I ICip I <br /> C �� <br /> I � <br /> ❑ DEMOLITION O COMBINATION D�BUILDING �[CNANICAL ❑ PLUMBING ❑ SIGN <br /> M�ii �PfiNl 9ti O :•P P��nrll <br /> J � <br /> ,_ <br /> 7 ^PO ' PY � 11 �,�,��/5�� 7-/�'!� '��l S� UJ� `��J�-��('�L'('��U %�' 70r/ f���7�5�7 5�/:� <br /> �II( 1!t ���IV!� \i1�Y1H M�•� • <br /> 1'��I)111 <br /> .Sr< ��sl�� �/e 7�� y- ys�`'�-l�� )� f ii�� . � i/ >�Ps �n �S'3 S 3S3 <br /> ��J"' ` �7`rnu' o�t << � � , <br /> ��� �„�N� � ��•�:� . <br /> u�ru�v�. uicor�*u.nnn u.�, •ruat.s -�uNSN�� � 4 9 r�n <br /> � ( G !�P PqONE <br /> I41h�_ <br /> �'I.IMfl�N.��:.)Yffl1(.Ir1H MIII ��IIRESS <br /> i �tY AC P��UN[ I n 1 r <br /> 1'n • <br /> 0��51 ni y�nlu <br /> ❑ NEW � ADDITIpN ❑ ALTERATION ❑ qEPAIR ❑ DEMOLIIIUN ❑ WOODSTOVE/FRPL INSERT ❑ yUILDING RELOCATION <br /> N S H <br /> ✓°�'�� � - <br /> �RiNf WJN� <br /> uti� i� n�ui � <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP <br /> PLICAT101v 4ND KNOW THE SAME 70 BE TRUE ANDCORRECT.Al L <br /> iinants n�ar�ov���nuoi�cnrv,s�owr�nciownn�iuc.•rouncuo�ts� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISiVP[ <br /> i,�, p�„�K_�� � OF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE� <br /> INOfiNOT iHEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTNORITV TO VIOLATE OR GANCEI THE PqOVISIONS Of <br /> ANV OTHER S1ATE OR LOCAL lAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNPT�IIiE1H OON�Pe!'�(1HU,'�A�JiIiQpIIFOAGFNi <br /> //� L4fF <br /> X.'r�G—s✓� /�Y^' ✓'�f �_ 1� `{.`—' <br /> VROIlO.10URF55 J / <br /> �� � 'PS ♦��Vf�Nf�CIf�Bi14NlGtiia:lhlFY <br /> �/ � J 7- oo'`�� .T ' � r/e e1/l ��.� ` 1' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WIITER CLOSET�TOILETI A�C —RiHNOLG UNITS—M P <br /> BATHTUB HEFRICERATION UNITS—H P EA <br /> . LAVATORV IWASM B�SIN� BOILERS—B T U�H P <br /> $MOWER Gn5 FIqED�C UNITS—9 T U <br /> 1(ITCHEN SINN 6 DISP FpqCEO A111 SYSTEMS—B T U M EA <br /> � DISMWASHER WALI HEATEA$—B T U M <br /> LAUNDRY iR�Y UNI'f MEATERS—0 T U M <br /> CIOTMES WASNEN EVRPORA7WECOOLERS � <br /> UNIN�L CLOTMES DRVERS <br /> OfiINIaNG FOUNTaIN VENTIUTION FAN <br /> FLOON ORAIN PANGE HOOD <br /> BACKFIOW P9EVENIERS WATERHEATER <br /> ROOF DFlAINS—p�IN1.EA0ER5 WOOD S70VE <br /> S�NN�SEPVICE—BAR ETC 1 METAL FIREPUCE d CHIMNEY <br /> FIREPIACE INSERT <br /> MEATPUMP <br /> GAS PIPING <br /> E%N�USTFAN <br /> fUSTOiAL f SUBTOTAL <br /> PERMIi f P[NMIT <br /> T071L FEE f TOT�L FEE <br /> "� �.� +I�He� . aNn 5F�B�c. 5i0f SC�Aef.n ✓Ln�+CMECK NUMPER FEE r RECEIPT NO <br /> ,.,t :�nn ionnt� _ ' � _ ' ' � �' _ /. ': , . �1 <br /> wcn� �n. FEES VALUATION FEE <br /> .S/�CI # �5'S,3 Jr'J2 'LO �rEs n <br /> '�� "� O(�cuv�ry�iGR011v NqOfnWtIIMGUNrts Bl11LDWG <br /> � 'l� �t,f _ / / — . <br /> PLUMBWG <br /> ��r n.. No ur s�nairs M•R ocr, ioeo <br /> P�6�� ./� MECHANICAL <br /> /V <br /> OTNER <br /> fIRE SPRiNNLERS REOUIREO ❑ YES NO $TqTE BUILDING SUFCHARGE <br /> SiATEENERGYSUFCHARGE <br /> ..'• - ��.�i. A. VI/NSfr4V1_Oflr 4i��u �cuiti����rytlfl� <br /> PUBLIC WORNS <br /> \ ��\ /� G � � TOTAL <br /> PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY UNE LGCATIONS AND RELAiED EASEMENTS. <br />