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APPLIC�.+ i ION FOR CONSTRI,.:T10N <br /> ,. �,,..,,.,. <br /> PERMIT <br /> �,�„ �„ -�,� <br /> everett �e <br /> BUILDING DEPARiMENT -- <br /> 2s9-neto TO BE COMPLETED IN INK— PLEASE PRINT <br /> �„tinu� �. �,.�. i��. // (, r m�oe - <br /> � M �L�Z-J�L' T_ 7 L- ��f� '-1, �.�� ` C���-l. L� /i C '�a..l r � /']r�CJ� �.3 :� � �:.� � Vl <br /> � rd �i�+ NI �• �ODRESti <br /> � J[Lu,�c <br /> p H >��UuiKtON0E5�GN[R � MeR�0011E55 t:il✓- � -� 2�� � PMONE <br /> t � � -�-� ---- - -- --- <br /> � ((�� .lNER�LGONfP^1�G1pF MAIL��ONESS CIIY 21V FIIONI ULEN'il • <br /> � � � MfCNAN1�N1R�6 p - - M�IL��ORE53 GiIY - LIP PIroN[ --- �ICEN51 • <br /> � �y �`WMB�NGCONtM Ip� M�IIADDNE55 LiiY TiP nr10NC Uf,EN51 • <br /> d <br /> O '(+� <br /> Ht�1 CleSSorNOnw --___-_-'- _-._.___ ...___--_---'---_' --_'- <br /> N ❑ NEW ❑ RD�ITION ❑ pLiERA7lON y REPRIR ❑ DEMOU110N ❑ WOODSiOVbFRPLINSERi ❑ BUILDINGRELOCATION <br /> N _- -_____. _._.._--._____- _ .-_- __—____ . <br /> _---__ <br /> N 1LN�NiIMPPOVlMfN10NINiEPIOR N[MODEIO�NIY/ � CON/iA�C1VkR50N�NDPHONCNO <br /> N fONfRAGiP(IICEOiMYIDM `��� � �/�/I�Y19�( ' (�J ��l / -�(�. .. <br /> - � -- — - «L—�--�� <br /> [ICSCRiBEWOPe�NDSOU�u[i00GGEiNWLVEO --�yTl'(�L�� � <br /> � o y _ 1 �-p Inc e. _ <br /> r� l�o�nl C�v� �mti#-�c•r'cl� . � L�c.�� �� � ��c� `7�_�/_.1a�� 1 L. - <br /> � ruoroseouseo�eunoX.�e ' <br /> q / IHCRf.I�VGFRTIFV'MATIh1AVfNfF �NDEXAMINEDTNISAPPLICAiION/Np <br /> py ��C ��Q %ISt��� ' US1�. _ KNOW'HCSAME106[iRU[aNOCORRECTALIPROVI510NSC�LnWSAND <br /> i(G40ESCHiPUONOiPOPEP1Vi5NJWNflfl UPeTlACe10UnCOPIE51 ��Ff)IIJqNCESGOVERNING1H15TVPCOFWORKWILL8EC01dFLETEDWIT/1 <br /> WHEiRERSPFCIFI[OHEliEINORN01 TNEGiiFN11NGOFAPERMITDOESNOT <br /> �'�[SUME TO GNE AUTIIOiiITY TO VIOLFTE OR CANC[L THE PROVISIpNS OF <br /> �r.l BloCv__ or ____ - ANVOTIIER51F1EO�LOGFLLAWREGULATINGCONSiRUCTIONO�TN[PER� <br /> FOPM4NCE O�f.ONSiRIICTION THA7 I AM AU7MORIZED BY iHE OWNER OF <br /> THI$PROPERT�TO�ERFORM THE N'URK POR W HICH APPLIC�TION IS MFDE <br /> - - - AND I COMPLY WR4 THE 57AT[ CONTR0.CTOR5 LAW i827 RCN' AND <br /> 795IOOW4C G�....,���.� <br /> �����. mno �-�«wrwcu«�a�� nc�i. lo�//ul5`J <br /> (`���,. /���',�.�� <br /> i,—�oiec��aon¢ss -----.... . ��i�`;�/�� �. . . <br /> i, � .�.. ��uS��i�,� Iq�,im��uiro� �.iti��i>r.�r <br /> ;;'�� Cr �,�.- �>-. �"��_� �_N � <br /> O:UMBING MECHANICAL <br /> i <br /> � . NO. TYPEOFFI%TURE ORITEM FEE N9. TYPE OFEOUIPMENT FEE <br /> I WATER CLOSET ITOILEiI /+'C--A'MNDLG IINITS�-11 P <br /> �� BATNTU9 f��qf,F'.OAIRSYSiEh1S-- [3TU MCA <br /> IAVATORVIWA511AA$IM UNITNfAiERS�- �TU �d <br /> 1 -_ _ __ <br /> SHOWER CIOTHFSURYCRS <br /> ��� NITCHEN SINK 8 DISP `JI.NiILATION�AN <br /> �1 DISHWASHER �74NGE MOOD � � <br /> LAUNDRYTRAV WATERN[A7[R . . . <br /> CLOTHESWASMER wOODSiOVE � <br /> �� URINAL ti�F.TAL PIREPLACE M1 CNIAINEY <br /> ' -_- - __ _ .._.___'__. <br /> I ��� DRINKINGFOUN7AW nnFPLnCE1N5[FT . <br /> i -______ .___. _ <br /> FIOOR�RAW HEAIPUMP <br /> _ - . " . __-_ __.. <br /> BACKF�OW PREVENTERS GAS PiPING � <br /> _ R(�F Di7AINS-RAINLEADEFS C%HAUST�AN <br /> 1 -- .—__ -__- .. ._ . _ __ . <br /> � SINK�SERVICE-BAR,ETC� __ <br /> � _'.' __-._.__-____. <br /> + '�I_I _ -__'-_ _-_ - �_-___. -._ ______'_'-_'- . <br /> ___' <br /> � SUBTOTAI S SUBTOTAL S <br /> '__—'__.__'________"__.-_ _" - <br /> PEPMIT S �Cf�S1R S <br /> I �'_' - ---""� �TO1ALf[i .�.�. .f IOTAL �EE 5 <br /> � fRONI 5[1N�CF lil u.�I�fl<t.r Sipl!111PAt n PIAN CNFCR NUMqEP ifE PFCEIP!HO <br /> �, <br /> .________ . ._. ._ ..._. _ __. .___ _ <br /> ast mwe un eme - � v�c�n�sin FEES �A�UATION FEE <br /> rrs r�u �e-��� <br /> lY>EOfCAH91 OCCUP�NCYUROU� � NOOfpWEIIIN��.u'.��'� �UII I)ING �Y ) r�� I 1 <br /> /Ll <br /> 4lQWBLE/�CTU�L <br /> PL UAIBING <br /> s�aeoraioa � no�i��•.n�.mr, �i�,.�n � ��ccic.n __ <br /> � MfCHANICAI _ . _ <br /> �,i „��.i�v.var�q OTHER <br /> �tliE9PRINMlERSPEO�IIPED ❑YES n� - G <br /> _ . 57ATE BUILDINQ SURCIIARGf � �� <br /> STATE ENERG�SURGNa�vGE } <br /> �nYlIC�110H�CLBV �UNS��'�'nPr �I <br /> � "���� i Pl10lIC WOPKS _ <br /> � I TOTAL � , � <br />