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Ei ..'1 � <br />1��EvuprNn . • ■•'�PLICATION FOFi�"�) . ; . .. e�e,e„ <br />��tt�F CONSTRUCTION � <br />everett � PERMIT <br />BUIIDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAI. ❑ PLUMBING SIGN <br />OWNER ,� MRILAO�RE55 ��T�" Z�P PNONE <br />��- v c� �.� T� i�►�. � a� F ��,��EN ��.�, 9e �z a �� - s-Z c, 3 <br />�NGHIIECIORDESIGNEP MRILRU�RE55 Utt ZIP PHONE <br />SfHtKR�tLGONTPRCTOp M.ILP��OE55 1 CIIY 21P PIIONE �ICE��yE� <br />ME.I'Z st�-�� co itic. ��a-�a-trl�tilo2 ho�r.l�. S�_S2�ic�9 C�a-�I-�IJ1-l3 z,���,,, <br />..e�u.u��e�rnutecma M�ILAUONE55 ��N ZiP PHONE lICE115E• <br />PLUMBiN6LONIRACIOR M�RADDRE55 CIfY 21V ' PIIONE LICENSE� <br />:� <br />CL� OF WORR <br />NEW ❑ ADDITION ❑ ALTEPATIUN ❑ AEPAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALWiiON f�lF WOfiN�COST OF MAfERIq�S f'LUS LA001i1 � <br />�l S CaC�� ��I lt� S l� �a - 1\0��4= W t�.��.. 5 l C1r1 � S C�'�� , <br />�ESCRIOEWORK T � � . <br />I�l ST,d�.�-- l"� � I L,� M�l �I � s��'� ^� � � � r- rin M- ���u r-�. w r�sweJ <br />G ,p� S � l_ �S <br />'180 � <br />PLUMBING <br />VO. TYPE OF FIl(TURE O� <br />� WATER CLOSET (TOILET) <br />BATHTUB <br />� LAVATOFYIWASH BASIN� <br />SHOWER <br />NITCHEN S�NK 8 DISP. <br />� - �ISHWASHER <br />" LAUNDRYTRAY <br />� CLOTHES WASHER <br />' URINAL' � ' ' ' � <br />�� ORINKING POUNTAIN <br />FLOOF D�7AiN ' <br />BACKFLOW PREVENTERS � <br />ROOF ORAINS — RAINLEA�ERS <br />SiNK (SEflVICE — BAR. EfC.) <br />USE ION� I <br />` �I <br />iYPE OF CONSi. <br />5¢EOF9L00. ' <br />FIRE SPRINKLERI <br />RVPLICAiION �CC. BV <br />SUB TOTAL <br />PkNMIT <br />TOTALfEE <br />NE�H SETBRGK <br />NOAF STORIES <br />FOUB COPIES� <br />V�CANT SIiE <br />OYES ONO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICAT�ONAND KNOW THE SAME TO BE TRUE ANDCORRECT. AL� <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTFIISTYPE <br />OF WORK\NILL BE COMPLETED WITH WHETHC•R SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNA OFCONTFACTOR OR AUTHORIZED AGENT OAiE <br />X � � ,. _ ' _ <br />n t 1'v�n n � <br />3 <br />MECHANICAL <br />fEE NO. TYFE OF EOUIVME <br />A/C — A/HNDLG UNITS — H.P. <br />FEFPIGERATION UNIT$—H.P. EA. <br />BOILERS — B.T.U./H.P. <br />GAS FIREO A.C. UNITS — B.T.U. <br />FORCE� AIF SYSTEMS — B.T.U. <br />WAIL HEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLO7HES �RYERS ' <br />VEN7ILATION FAN <br />RANGEHOOD <br />WOODSTOVE � <br />METAL FIREPLACE 6 CHIMNEV <br />• FIFEPLACEINSERT <br />HEATPUMP <br />GAS PIPING � <br />E%HAUSTFAN <br />IINIiS <br />•P�N. FOP ISSURNCE OY <br />�� <br />PIAN CMECR NUM6ER <br />SUBTOTAL <br />FEE <br />FEES ` <br />�U�LDING 5 <br />PL4MBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SUPCHARGE <br />STATE ENERGY SUFiCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M G. <br />M <br />M <br />FEE <br />RECEIPi NO. <br />PROPERTY OWNERS ARE PESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LaCATIONSAND RELATED [ASEMENTS. <br />11 <br />