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'����"PPLICATION FO:..�� ���,�„ <br /> `�'E"ro`�� �,CONSTRUCTION <br /> Gn oF <br /> everett PERMIT e <br /> SUILDING DEPARTMENT <br /> 259•8870 TO 8E COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL �UMBING O SIGN <br /> OWNCA / MuIAD�RE59 Gli�' ZIP pqpv' <br /> � ��,4 �ID�/Ci �a.r/ h�7_02- !°n���v l'u r _� 9�Zo/ � Z-Q50� <br /> �RCMrtEf.f OR OLSIG4ER M�q�D�RES I pllY 21G PMpNE <br /> GENERALCONTq�LIOP M�ILADDRE55 C11V P PNONE LICEHSC• <br /> n� v � ��' �'� P�U.vI�,;va l�� �ox /�ZI /���to� 9�ayG 77S=Gy�y <br /> MECHe ��� 'ON H�C�OR M�IL RE55 CIfY 21P PHONE D qV/� , _ 7 <br /> K/�� <br /> �LUM9INOCON1PALiOF M11L�DONE55 CIiV ZIP PIIDNE tICENSE• <br /> CLA55 0�WOqN <br /> ❑ NEW ❑ ADDt1�ON ❑ ALTERA7ION REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.IN�ERT ❑ BUIIDING RELOLATION <br /> V�W�t10N Of WORN�COSt O�MAIERIµS�IUS LRBAN� <br /> OESf,RIBE WORK <br /> �L � <br /> USE O BU DiNO <br /> � S� Id I� �QM/ I�I I HEREBY CERriFY THA7 I HAVE READ AND EXAMINED Tfi1S AP- <br /> PLICATIOM AND KNOW THE SAME TO BE TRUF qNDCORRECT.ALL <br /> iw.ioe IPiIONO�PROPEPiY�6H WNBELOWOH�IT�CHiOUFCOPi[51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WIIL BE COMPI ETED WITH WHETHEH SPECIFIED HERE• <br /> �o+—eiocti_or IN OR NOT.THE GRANTIhG OF A PERMIT DOES NOT PRESUME TO <br /> - GNE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANVOSHERSTATEORLOCALLAWREGUL TIN�CONSTRUCiION <br /> ORTHEPERFORMANC FCONSTRUC N. <br /> S�GN�tURE Of 4CT0 R AUTH N G� G D E/` <br /> X G �Z / �� <br /> PROJECi�DDRE55 APPIIG iSClf BUSMCSSl�CL115EN <br /> • yZo Z C <br /> PLUMSIN6 MECHANICAL <br /> NO. TYPE OF fl%TURE ON ITEM FEE NO. TYPE OF EOUIVMENT FEE <br /> W�TEN CLOSET�TO�LET� q/C—�/HNOLO UNITS—H P. <br /> OATHTUB REFRIGEP.ATION UNITS-•NP.E4. <br /> UVATORY(WASM B�SIN) BOILERS—B.T.U1H P. <br /> SMOWER 6A5 FIRED AC.UNITS—B.T.U. <br /> KITCMEN SINK{DISP. FORCfO�IR SYSTEMS—B.T.U. M EA. <br /> OISHWASHER WAILHEATEF3—B.T.U. M <br /> UUNORYTR�V UNITMEITERS—B.LLL M <br /> CLOTHES W�SHER EVAPOP.ATIVE COOLERS <br /> URINIIL CIOTHE3 DRVERS <br /> DR:NKIN�fOUNTAIN VENTIUTION FAN <br />� FLOOR DR�IN � R�NGE HOOO <br /> BACKFIOWPiIEVENTERS WATERHEATER . <br /> i ROOFDRI11N5—R�INLEADERS WOODSTOVE <br /> SINK�SEAVICE—BI1R.ETQ� METAL RREPUCE a CMIMNEV <br /> FIREFUCE INSERT <br /> NEATPUMP <br />� GAS PIPINO <br /> I E%H�USTFAN <br /> I <br /> d <br /> fUlTOTAL f bUlTOTAL <br /> PERMIT f P[qMIT <br /> T0T11L FEE f TOTAL FEE <br /> 1RONi5E18�CK qEAq5E1B�CK SI�ESETBApK �ANCMECKNUM9ER FEE NECEIPTNO. <br />! VSEZONE LOTAqE� y��ANi51IE FEES VALUATION FEE <br />� OYES ONO <br /> TYPEOF�ONST p��UP�NCYGROUP NODFDWEILINQVNlT9 BUILDING S <br /> 1 <br /> PLUMBING <br />' SRE Oi BLDO NO Of 4tORiE3 M�%-0CC LOAO <br />' MECNANICAL <br /> OTMER <br /> FIRE SPRINKLERS REOUIRED ❑VES ❑ NO STATE BUILDINd SURCHAAGE <br /> STATEENERGYSURCHARGE <br /> �VPIiG��IONRGC B• PUNSCMEG1tE0BY �PPI! IORISSU�NCEBV <br /> PUBUC WORK9 <br /> TOTAL <br /> � <br /> PROPERTY OWNERS ARE RESPONSIDLE FOF�EiERMINING AlL <br /> � PROPERTYLINE LOCATIONSAND REIATED EASEMENTS. <br /> 1 <br />