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f� � � <br /> .�PPLICATION FG .: <br /> fMErHpn�rt CO N 5TR U CTI O N `°�"" <br /> Qr OF <br /> everett PE R M I T e <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> �EjIDEMOLITION ❑ COM9INATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNE / M�iL�DORE55 CiTV ZIP PHON! <br /> A�r Yr 33 3 0 /ffc ,�.c.�.✓/ �a.�.� W.�. 9S.2a/ <br /> •RCHITECTORDESIGNER M�ILADORE55 � CITv ZIV PMONE <br /> �-�.5,6•�. P�r.T. G. l�.e • ,a.X �,z�9 E�,�.f� lv�.nl 4�,?.E .�SP-s�t7 <br /> GENERALGONTRRLTOR MRIL AODRE55 CIiY ZIP PHONE LICENSE� <br /> MEGM�NiUL CONTR�LTOq MML�pDRE55 CiTV ZiP FnONE UCENS[� <br /> PWMBiNGCONtP�GTOR M�iL�DDAE55 GTY 2iP PMONE LIC[NSE• <br /> CUSS OF WOqK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�LU^�TION OF WOAN iCOST OF M�TERI��S PWS L�BORI / <br /> I�Mi �` �1/L/ T'��y /Y�tf1C 5 <br /> OESCRiBE WORN �� � <br /> USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVi READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAMIi TO BE TRUE AND CORRECT.ALL <br /> iea��oFySG(iPTIONOiPNOGERiY�SHOWNBELOWOP�TT�GNFOURGOPiE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> ��� �(��/�, /Lr �� OFWORKWILLBECOMPIETEDN'ITHWHETHERSPECIFIEDHERE- <br /> �o*�e�oc��Yi-or IN OR NOT.THE GflANTING OF A Pi RMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR Ci�i�10EL THE PROVISIONS O� <br /> ANYO HERSTATEORLOCALl4WREGUTATINGCONSTRUCTION <br /> OR T PERFORMANCE OF C4NSTRUI:TION. <br /> SIGNA U E OF CONiRFCTOP OR AU'r10RIIED AGENT DATE �I//3� <br /> X ,/ �-- <br /> PAOJECTADORE55 �PP CANTSCITYBUSINESSLICC� <br /> .�s�q ,-. <br /> PLUMSIN6 MECMANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIET) AIRCOND. UNITS—H.P. EA. <br /> BATMTUB REFRIGERATION UNITS—HP.EA. <br /> LAVATOPY IWASH BASIN) BOILERS—HP.EA. <br /> SHOWER GAS FIRED AC. UNITS—TONNAGE EA <br /> NITCHEN SINK 6 DISP. FORCED Alfi$YSTEMS-B.T U. M EA. <br /> DISHWASHEF WALL NEATERS-B.T.U. M <br /> LAUNDRYTRAV UNITHEA'ERS-B.T.U. M <br /> CLOTHES WASHER EVAPORATIVECOOLERS <br /> WATER HEATER CLOTHES DRVERS <br /> URINAL VENTIlAT10N FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- QF.M. <br /> VRCUUM BREANERS STOVE <br /> ROOF DRAINS-RAINLEADERS METAI F'IREPLAGE 8 CHIMNEV <br /> SINK SERVICE-BAR,ETC. WOODSTOVE/FIPEPLFCE INSERT <br /> 6UB TOTAL SUBTOTAL f <br /> PEXM11 i PERMIT f <br /> TOTALFEE { TOTRLFEE f <br /> THIS PORTION TO BE COMPLETED BY SUI!DING DEPT. PERSONNEL <br /> fqONTS[iBACK REARSETB4CN $IOESETBACN PLRNGNECNNUMBER FLRNCHELNGEE <br /> FEE RECEIPi NO. <br /> USEZONE LOi�REA y���NTSIiE <br /> pYES OND FEEB ���UATION FEE <br /> T�'PEOfCONSi OCCUPRNCYGROUP NOAFOWELLINOONITS <br /> BUILDING S <br /> SIZE OF BtDG NOAF STORIES MAX OCG LORD <br /> PLUMBING <br /> MECMANICAL <br /> fIRE SPRINKLERS REOUIRED ❑VES ❑ NO <br /> OTNER <br /> PENALTV <br /> APPLiCAlION ACC BY PLANS CHECNED BY APPR.fORI55UANCE BY - - <br /> TOTAL <br /> : � I <br />