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rcr. . — <br /> ,�.EW,o,,,� APPLI�CATION � OR ���,�„ <br /> ��TM�F CONSTRUCTION e <br /> everett PERMIT <br /> TO BF.COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ Cph1BINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING � SIGN <br /> owruen / M+a�onR=_ss cim nr P11011E <br /> P,v / �v n,4�� io��s �r�.�G�.,�,� w�*y �,.��- <br /> MLIIItECtORDE510NER N�ILADDRE55 CIiY 2iP PIIGNE <br /> OENEMLCONIP�CfOR ��AILADDflES GI1Y IiP f+r^::[ UCFNSF• <br /> .���1?�d •l���vc. //d�Ds'�//6� .�/�L�Cl.�/v y'�3� �i�'-�3/00 ,, ' r,�xlt�o�J <br /> MECH�NICQ CONIflACTOfl �dR�l AOORLSS CIIV ZIP 1'�ION[ IICENSE� <br /> �LUM9INOCONIRRCiOR M�ILAD�RE55 CIiY 21P PIIONE LICENSE+ <br /> GlA55Of WORN <br /> NEW ❑ ADOITIQN ❑ ALTF.RATION ❑ REPAIR ❑ DEAtOLITION ❑ WOODSTOVE/FRPL.INSF.RT ❑ BUILDING RELOCATION <br /> V�LU ONOFWORN�WSiOFM4i[NIALSPWSLABOR) <br /> �� Q�O o0 <br /> DESGRIBE WORK . � • � _ <br /> /Aj.�r�.f GC� S,�G R/ D.t� GD G- � �C"t , ��•-Y-lCf <br /> USE OF BUILOING <br /> I HEREBY CERTIFY TI1AT I flAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KN�+:VTHE SAME TO BE TRUEAND CORRECT.ALL <br /> IEGRLDESCRIPIIONOFPROFEHTY�SNOWNBELOWORATT0.LNF0URGOPIE51 pROVISIONSOFI/..�:SANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE- <br /> �or_e�ocK_or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TG <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMA�JCE OF CONSTRUCTION. <br /> SIGNATURE OF CONiRACTOR OR AUTFIOR12ED AGENT OATE <br /> X� � ,.�«.� -/J�� <br /> PROJEGTq00RE5S /�PLICRNiSC1iY0U51NE55UCE NO- <br /> :D / �' <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI1(7UPE FEE NO. 7YPE OF EOUIPMEN7 FEE <br /> WA7ER CLOSET�701LEp AIR COND. UNITS-N.P.EA. <br /> BATHTUB REFRIGERA710N UNI1S-H.P.EA <br /> LAVATORY�WASH BASIN) BOILERS-H.P.EA. <br /> SHOJlER GAS FIRED A.C.UNITS-�ONN�GE EA. <br /> KITCHEN SINK 8 OISP. FORCED AIfl SYSTEMS-B.T.U. M EA. <br /> DISHWASfiER WALL HEATERS-B.T.U. M <br /> LAUNDRY TRAV UNIT HEATERS-B.T.U. M <br /> CLOTHES WASHEF EV�PORATIVE COOLERS _ <br /> R'ATER HEATER CLOTHC-S DRYERS _ <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNiAIN RANGE HOOD _ <br /> FLOOF DfiAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAHERS STOVE <br /> ROOF DRAINS-FAINLEADERS METAL FIHEPLACE 8 CIIIMNEY <br /> SINK SEPVICE-BAR,ETC. WOOOSTOVE/FIREPLACE INS[FT <br /> SUBTOTAL SUBTOTAL 5 <br /> oFpMIT S PEflM1T 5 <br /> TO7ALFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSO�dNEL <br /> FRONTSLIBACN PEIRSET94CN SIDESETBAf.{ PLFNGMECKNUh10ER VIAIlC��ELKFEE <br /> FEE f1ECEIPi NO <br /> VSE20NE LOTANER VACANiSIIE <br /> FEES VALUATION FEE <br /> �YES ONO <br /> ttPEOFCONST. OLC"PANCYGNOUP NO.OFUWELLINOUNIfS <br /> BUILOING 3 <br /> SIZEOFBlD6. NO.OFSiORIES Mrl%.00QIORD — <br /> PLUM�ING <br /> MECHANICAL <br /> FIRE SPRINKLERS FEOUIRED ❑ YES ❑ NO <br /> OTHER <br /> PENALTY <br /> RPPULAfIONACC.OY PUNSCHECKEDBY BP FO ISSOANCEBY <br /> TOTAL <br /> �� J <br />