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, .r'PLICATION F0►_ ���,�„ <br /> '°.E""""' CONSTRUCTION <br /> c�n or <br /> everett PERMIT <br /> BUlLDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION O COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEN MAILA�ORE55 CITY 21� PNONE <br /> 1 <br /> �I�ARx11otJT ►/�N�ne Qs�ac Illv /b11� �l•rc. 1�.�. � Su� c ,'��v !��/�E�-u� 6U�, S;zr�n4 �>X�s-9�.5e <br /> AqCNttECiOH0E5iGNER MM�AOOHE55 Cltt 21P P�IONE ,`�a/d�' ��y.r� <br /> I_t.F !-o�,�.taNO /issoc. PicR 7� Su;lc 33 , a81� c1/c�ka� l.ik:y . Si��/l% G�G. �14/.9,4� <br /> GENEHALCONIPAGIOfI M�ILApOfiESS Cltt I' 21P VBONE 4CENSE� <br /> MEGHANIL�L'LONtP�GiOfl �V. �D AIL ���/5����� / 'uC It�V . ���� (� 'NH O!O��l��� LICENSE• <br /> t�;dd<R »�S,qti � <br /> PLUMBINGGONiR�CTOR � M�ILRODFE55 GITY 21P PHONE �ICENS[• <br /> CL�55OF WOHN <br /> ❑ NEW ❑ ADDITION �J ALTEf{q710N ❑ RcPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br /> VALV�l10N OF WORh ILOST OL IA�IENIRLS PW 5 L�BOR� <br /> � Y3 U00 <br /> OESGflIBE W�O-HtK <br /> /PnGn� I'HhRGyCHc�'7� <br /> useorewimNc ! � • <br /> Q I I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEU THIS AP- <br /> r�C70.i PLICA'fION AND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> LEO�L�ESLNIPLIONOFPROPEIITV�SHOWNBELOWOHATTACHFOUPCOPIE51 pqpVYSIUN50FLAWSANDORDINANCESaOVERNINGTH�STYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HERE• <br /> ior—e�oc�—oF IY OFI NOT.THE GRANTING OF A PERMIT DOES N0T PNESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL ?HE PROVISIONS OK <br /> , / ANYOTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR"fHE PERFORMANCE OF CONSTRUCTION. <br /> SIGIlAiUPEOFCONTRACTOf70RAUTHORIZEUAGENT DATE <br /> X GC .� �JLL-s(,CC�v �S C3 <br /> PROJEGi��DRE55 pP�'LICRNPS CILY BUS Wl55 LICENSE N0. <br /> Hy�y �ra r�cN (,�la <br /> NLUM61N6 MECHANICAL <br /> NO. TYPE OF FIXTUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER ClOSET�TOILET) AIR COND. UNITS–H.P.EA. <br /> BATHTUB REFRIGERATION UNITS–H.P.EA. <br /> LAVhTOflV IWA511 BASIN) BOILERS–H.P.EA. <br /> SHOWER GAS FIRED AC. UNITS–TONNAGE EA <br /> KITCHEN SINKB�ISP. FORCED AIR SYSTEAIS–B.T.U. M EA. <br /> OISHWASHER WALL HEATERS-6.T.U. M _ <br /> LAUNOfiYTRAV UNITHEATE175–B.7.U. M <br /> CLOTHES WASHER EVAPORqTIVE COOLERS <br /> WATEF HEATER CLO7HE5 ORYERS _ <br /> URINAI VEN7ILATION FAN <br /> URINKING FOUNTAIN RANGE HO00 <br /> FLOOH DRAIN AIFi HANDLIHG UNI7– QF.M. <br /> VFCUUM OREAKCNS S70VE <br /> ROOF DRAINS--RAI�LEADERS METAL FIREPLACE 8 CHIMNE� <br /> SINK(SERVICE–BAR.E7C.) WOODSTOVE/FIREPI.ACE INSERT <br /> SUBTOTAL SUBTOTAL S <br /> PENMIT S PERMII' S <br /> TOTALFEE ! 70TALFEE S <br /> THIS PORTION TO BE COMPLEl'ED BY BUILDING DEPT. PFRSONNEL <br /> FqONiSEIB�CB flE4R5E78RCK SI�ESETBACK PUNGHEGNNUMBER �7�P��ANCIIECnFEE <br /> ' ' � � � �j� ' I'][]�� FEE�QS�Y �EG[IPiN0�1C�/� <br /> USE 20NE LOT AAEA �� � � � � ~� ` <br /> VACRN7 SI7E FEES \'ALUpT10N FEE <br /> �— � ��i� ores qH0 <br /> ttPEOFCONST. OCCUPnNCYGROOP NO.OF�WELUNGl1NIi5 <br /> ���I � — Z BUILDING frj'�QO�� y,S <br /> SIZE OP BL00. N0.OF SIORIES MnX OCC.LOnD '" <br /> nO!� .� ' �!j PLUMBINQ <br /> MECMANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES NO <br /> - OTI IER <br /> PEHALTY <br /> RPPLICRt10N ACC.BY PLANS CNECNEU BY APPN.FOR ISSU�NGE BY — <br /> TOTAL <br /> 4.�e L�• ��,�� ��t � M�-s� <br /> ��iT JZt�`n. <br />