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J <br /> iIMEwrprNn �PP��CATION Fa�.� _ ���,�„ <br /> ��TM�F CONSTRUCTION <br /> � everett PERMIT e <br /> � BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �PLUMBING O SIGN <br /> '� owNen - Meiieoor,is�/O-//O cirv. i zir PIION <br /> C�.�A 2t-�^•o••��J�c.cY�ct �q-SSce, 1 i fa -!o�'��I i n.�r. ;i�,��t• 3i u !je!.ct��uo `�5'0�� `a'�S—i J-So <br /> APCHITEGTOROESIONEfl M�IL�pORESS Cltt IIP PMONE <br /> GENEP�IGONTP�CTOR MAILRDORESS CIiV 21P PNONE LICENSE• <br /> � MECH�NIL�ICONTH�CTOfl MRILA�ORE55 CIiY 21P PHONE LICENSE• <br /> I <br /> � PLUMBINOCONTR�CTOR • MRILADORE55 C�N ZIP PIIONE , IICENSE• <br /> - ►M��r �ti��t.�,.,�c�rc.z��c YL•,;d-�5����E'nIE �tD�rc��.� y5'nS�- �43�`11�-4- M42T�r�63 <br /> CU5S OF WONK <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINC� RELOCATION <br /> � VALU�TIONOfWORN�GOSTOFMATERIPLSPWSLA90111 <br /> I <br /> OESCqIBE WORN � • <br /> w�'�Z SeRv�c� 'i^'p E3ur�oi��G' S�x'.C'_. <br /> : UBEOFBl11lU:N0 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIu AP- <br /> � PLICATION AND KNOW THE SAME TO BETRUEANDCORRECT.ALL <br /> LEO�LUESCAIPTIONOFPPOPEPTY�9HOWNBELOWORIITTACNFOUNGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> � OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> � LOi�_BLOCN_OF INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> , GIVE AUTHORITY TO VIOLATE OR CANCEL THE PqOVISIONS O� <br /> ANY OTHER STATE OR LOCAL Li1W REGULATINCa CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> � <br /> SIONATIIREOF�pNTRACTORORAU ORIZEDACENT DATE /��(4`�6 <br /> ,' y /T <br /> '� ^ ..r.0 l_. . ��t.....��.-�`�-i <br /> PROJ'_CT�DONESS APPLIC SC�TYDUSINESSIICEN5EN0. <br /> �9 3 S 6VQ2C(tr� ��i <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> WAtER CLOSET TOILEn AIR CONO.UNITS—H.P.EA. <br /> �� BATHTUB REFRIGERA710N UNI75—H.P.EA.� <br /> LAVATORY WASH BASINI BOILERS—H.P.EA. <br /> SHOWER GAS FIREU AC.UNITS—TONNAGE EA <br /> KITGHEN SINKB�ISP. FORCED AIR SYS7EMS—B.T.U. M EA. <br /> DISHIVASHEF WALL HEATERS—B.T.U. M <br /> LAUNDRYTFAY 11NITHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVEGOOLERS <br /> WATEfi HEATER CLO711ES ORVEFS <br /> URINAL VENTILATION FAN <br /> DPINKING FOUNTAIN RANGE HOOD <br /> FLOOH ORA:N AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS S70VE <br /> ROOF DRAINS—RAINLEAOEHS METAL FIREPLACE d CHIMNEV <br /> 'i SINK SERVICE—BAR ETC. WOODSTOVE/FIREPLACEINSERT <br /> �' IJILa(w1C� ` /jyy'.�I <br /> SUBTOTAL SUBTO7AL t <br /> PEHM17 S PERMIT 5 <br /> TOTALFEE 2 TOTALFEE S _ <br /> THIS PORTION TO BE CQMPLETED BY BUILDING DEP7. PERSONNEL <br /> FRON*SETBACK fiEAFDcTB�CN SI�ESE7B�CN PLnNCHECKNUMBEH PLRNCHECNF�lE <br /> FEE PECEIPT NO. <br /> USE20NE LOTARE� VACANTSITE <br /> FEES V�LU�TION FEE <br /> OYES �NO <br /> TYPEOFCONSL � OCCUPANCYGNOl1P NO.OFOWELLINOUNITS <br /> BUILDING S <br /> SIEE OF BIDQ NO.OF STORIES MnIC OCC.LO�D <br /> '� PLUMBIN� <br /> .' <br /> M9CHANICAL <br /> FIRF.SPRINKLERS RE�UIFED 0 YES O NO <br /> OTHEfl <br /> PENRLTV <br /> RPPUCRLION RCC.BY PLANS GNECHEO BY APVR.FOB ISSURNCE BY <br /> TOTAL <br /> � <br /> � <br /> . .. .. . � . . . . <br /> .�.�..,i,..........._,_..._.. .. . . . . . . <br />