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--� �. <br /> �..'PLICATION FOR ���,�„ <br /> ""E"'°'"° CONSTRUCTION 0 <br /> ur oF <br /> everett PERINIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK • PLEl+�SE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUIIDING ❑ MECHANICAL ❑ PLUMBING XSIGN <br /> OWN <br /> M•n.00niss arv z�v nHor+e <br /> � ��Ou!{L1� S /0�20 NE Po�NTS n�' S'u�rc3�w KIRKIANL� �0.33 8�7'97eo <br /> �PCMIT[CTOFpLS�GNFR M�ILADDRE54 C�n' ZIP nqONC <br /> GENCR�L GONLR�LiOR M�IL AppR[55 CIiV ZiP Pr�ONC LICL45E• <br /> 6�m� iN� P�� Box �'9 LYNN� 9ga��� �-�6�ss f�'-rz�y �v�cd, <br /> MELMFNiUICONTF�LfOq MMI�ODRE55 C!iV Z�O PHON[ IJLENSf• <br /> FlUM81NaCONiR�GTOR MI.IL4�ORE55 LITv .'iP P�iONG IICENSE • <br /> Gl SOGWOAN <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ AEPAIR ❑ OEtAOLITION ❑ WOJDSiOVE/FRPL.INSERT ❑ BUILDING RELOCAiION <br /> V. �TIONOfWOFNICO51OfM�TCAiAl5PLU5UBCFi <br /> �l 530 "� <br /> DE9CR�B�WONK <br /> INSrA+-� l� � t S (u'-��rb /�L�NS <br /> uscor eu�toia, I HEREBY CER?IFY 7HA7 I NAVE READ AND EXAMINED THIS AP- <br /> Rc�,-�.��Mr PLICATIONANOKNOWTHESAMETOBETRUEANDCORRECT ALL <br /> iee4�oescuivr�or+orvr+oPearrisMowr+eeiowoaarucNrouncor¢si PROVISIONSOFLA\YSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> io�—e�oca—ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUtdE TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTFUCTION. <br /> SIGN�TUP Of CONTRAf.TOR p�1 AUi��ORI �D AGENT� �iC. �� <br /> �� <br /> X Q.h� . � 7 <br /> PROJECT e0DRE55 >PPL�GANTS LIIY BUSIN[55 UCCNSE NO <br /> � L 33 �5� � <br /> PLUMlIN6 MECHANICAL � <br /> Mp, TYPE OF FI%TI1RE FEE NO. iYVE OF EOUIPMENT FEE � <br /> W,4TER CLOSET TOILEn AIR COND. UNITS—HP.EA. <br /> BATMTUB REFFIGERATION UNITS—NP EA. ( <br /> LAVATOfiV�WFSH BASIN) DOILEFS—H.P.[A. � <br /> SHOWER GAS FlRED A C UNITS—TONNAGE EA "i <br /> KITCHEN SINN 8 DISB FORCEO AIR SYSi EMS—B.T.U. M EA. <br /> DISHINASNEN WALLMEATER$—dT.11. M i <br /> LAUNDFVTRAY UNITNEATER$—B.T.U. M <br /> CLOTNI°S WFSHER EVAPORATIVE COOLERS <br /> WATEA f'EATER CLOTNES DRYERS <br /> URINAL VENiILATION FAN <br /> DRINKMG�°OUNfAIN RANGE MO00 _ <br /> FLOOR ORAIN AIR MANDLING UNIT— C.F.M. <br /> VACUUM 9HEAKFAS STOVE <br /> ROOF DRAINS—F'AINLEADERS METAL FIREPIACE 8 CHIMNEV <br /> SINK�SERVICE-13AR.ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUB TOTAI f . <br /> PERMI7 f PERMIT f <br /> TOTALFEE t TOTRLFEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fPONiSETB�fN AERRSETOALN SIOESETB�CR cLnNCN[CNNUMBER nLANG�lGniCE <br /> fEE �ECEIPiNp <br /> USE20NE LOT�RE� y�L�AT51tE V�W�TION FEE <br /> FEEB <br /> ❑YES ONO i <br /> TYPEOFLONST OCCUP�NCYGPOUP NO.OFpWELLIN3UNIT5 <br /> BUILDINO S <br /> Si2C OF BLD6 NO.OF STORIES MA%OGL LOAO <br /> PLUMBINQ <br /> MECMANICRL <br /> FIRE SPRINKLERS REOUIRED ❑ VES � NO <br /> OTNER <br /> PENALTY <br /> nPPUG4+iON4CC �v PL�NSGMECNEOBY aPPRFORIS WN�EBY <br /> TOT�L <br /> ,y <br />