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;.,;y�y ..; � <br /> �:,..t t;.:.') <br /> ,�.E„ro,„� �ppPLICATION FOR'� <br /> air er <br /> CONSTRUCTION `""°" <br /> everett PERM IT e <br /> BUILDING DEPARTMENT <br /> 25�•87a5 TO BE COMPLE7ED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION. O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEN M�IL�DDRE 5 GI 21P PNONE <br /> /� � p <br /> • IfE�TOR ESI N B M�II pRE59 ITY ZiP PHONE . <br /> O[�EMLCONiP� 1 R AI�IL���NESS CI 21P PHONE LICENS • <br /> � Dl/j� ., <br /> MECN�NIC� CONT CT M I��OORE55 GIfY 21 PHONE � ,��`(,Q � � <br /> uGr�� <br /> PIUMBINOCONTR�LTOR MAIL�ODRE55 CIfY 21P PIIONE ���ENSE• <br /> CLASSOF WOR1c <br /> �NEW ❑ AODITION ❑ AITERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING REI.00ATION <br /> �LU�TION OF WOqR�W ST OF M�TERI�LS P�US LABORI <br /> d��2,�D <br /> DE RI NOP1( - <br /> �5-���►��rl-i� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP-� <br /> PLICATION AND KNON�THE SAME TO BETRUEANDCORRECf.ALL <br /> ���LEO�LUESCRIP710NOFPROPEXTY�SNOWNBELOWON�Tl�CHFOURCOPIES7 pqOVISIONSOFLAWS�INDORDlNANCESGOVERNINGTHISTYPE <br /> aM I�l oF (�_t1�r e� ym� rh)��_ OF WORK WILL BE COI.iPLETED WITH WHETHERSPECIFIED HERE• <br /> IN OR NOT.THE GRANTING OFA PERMITDOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> �IL A�L> � ANYOTHERSTATEORLOCALLqWREGULATINGCONSTRUCTION <br /> , . . OR THE PERFORMANCE OF CONSTRUCTION. � <br /> SIGNATU E. F CONTRRCTOR OR AUTNORI�. `AGENT �DATE <br /> X ., .� <br /> PR0.IECTADDPESS APPUC NTS If LJ"'ES LI ENS <br /> 47�2 Co,� ira� vE <br /> PLUMBINO MECHANICwL . � � . .. <br /> NO. TYFE OF FIXTURE FEE NO. � TYPE OF EOUIPM^NT fEE <br /> WATER CLOSET�"11LE � AIR COND.IINITS—H.P.EA � � <br /> BATITUB REFRIGERqTION UN�TS—H.P.EA <br /> LAVATORY WASH BA91 BOLLERS—H.P.EA ' �. i <br /> ' SHOWER OAS FIRED AC.UNITS—TONNAGE EA <br /> �_ KITCHEN SINKB DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DI3HWASHEf WALL HEATERS—B.T.U. M ' <br /> LAUNORYTNAV UNITHEATERS—B.T.U. M � � <br /> CLO7HE5 WASHEN EVAPORATIVE COOIERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN � RANGE HOOD <br /> FLOOR ORAIN AIR HANDLING UN�T— C.F.M. <br /> VACUUM BRE�KERS STOVE <br /> ROOF ORAINS—pAINLEA0ER5 METAI FIREPLACE 8 CHIMNEY <br /> $INK SERVICE—BAR ETC. WOODST VE/F E ACE NS RT <br /> � SUB TOTAL SIIB TOTAL ! � <br /> PERMIT S pERMIT t <br /> TOTA�FEE f TOTALFEE Q <br /> THIS PORTION TQ BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FqpNT 9ETBACI( REAq SETB�CK SiOE SETBACK FL�N CIIEC NUMOER VUN CMECK FEE <br /> �� �� � (J� � I U I � S FEE�^�C�_ RECEIPT NOQ/_/_l I� <br /> USEZONE LOTAREA a`�-��� ��s��0��� <br /> r� VA �NTSIiE <br /> � I I;v � / O�� �ES ONO FEEB VALUIITION FEE <br /> TYPEO�Fc ST. pCCI'P�+CYGROUP NO.OFDW LLINOUNITS <br /> Y _ � r'�-3 � ew�oiNa <br /> SRE Of BLDQJ NO.OF SIOPIES M�':OCC.LO�O <br /> �a� a N � PLUMBING .C771 <br /> , CN <br /> � MECHANIC�L <br /> FIRE SPRINKLERS REOUIRED ❑YES NO <br /> OTHER � � <br /> PENALTV <br /> �PPLIC�TIONAGC.BY P�ANSCHEGKEDBY �PPR.FOHISSUANGEBY � <br /> /� � T0TI1L r^ C/ <br /> C�C V/ 7l/ <br /> . <br /> � <br /> :..e`r-.w-ia.rT•�-- �-u ,.,.m,-:<•..�.,:..._.__:-.... .. .•--.. ..._- ... _.. _ . . <br />