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tMEnrprNn 4�:��'PLICATION FOf�'' ���,�„ <br /> Gr°F CONSTRUCTION <br /> eVerett PERMIT e <br /> BUILDING DEFARTMENT <br /> 259•8810 TO BE COMPLETED IN 1�►aK• RLEASE PRINT <br /> � t <br /> ❑ DEMOLITION ❑COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ S�GN <br /> � OWNER M�IL�D�RE55 CITY 2iP PMONE <br /> G9-R U L �-/F� ,�`� o r, S o✓� ,�vr w/�. 3 3 7- cf/ O� <br /> •RCHIiECfORDE5IGNEN� . MSIL�DOBE55 Lltt ZIP PMONC <br /> GENEP�L GONLR�CTOR MAiI �,OR[55 CiiY 21P PI�ONE KJ��4i K A. upENSE• <br /> � /y1'/Ke /�e//�i Pa,'., t 3 �o� s�` �v2 sw. � / 7''� r�r w.a. �'(a'2oy. `�`'�is� <br /> MECN�NIC�L CONiPACiOq MM AOONESS CILY 21P PMONE UCENSE• <br /> PLUMBiNGCONiReGIOR MAIL�ODRESS CitY 2iP P��ONE IICLNSE� <br /> C1�5:Oi WORN <br /> ❑ NEW ❑ AD�ITION ❑ ALTERATION REPAIfl ❑ DEMOl1TION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RELOCATION <br /> V�LU�TiONOFWnOqn�f.OSTj�M�IEBiAl5PLU5L�BON ' <br /> x �e lSva ]�� <br /> DESCPi E WOHN <br /> x � S, • <br /> uyor euuoiHc <br /> '�/ { � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> �ea.� SCRiPi10NOFPpOPEflIY15HOWN0ElOWORAIT�GIIFOUNCOP1E51 pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> q.b �(I Lq f�p p i�v� e`�B p g �f' OF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE• <br /> .oi_e�oc or INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO � <br /> � � � / ` � p GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> f yU._ p �t ,� ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE UF CONSTRUCTION. q p ! <br /> SIGN�TURGOFCONiR�CiOqpRAUTMOBIZEDAGENT pqTE //�/Q8 <br /> X �i��J � <br /> PROJEC/T�OONE55 /� �PCtiGNiS Li1Y OUSiNE55 LiCENSE NO <br /> /\ �( �� C O✓YI N�1 Cf/Cfi/ /�—V� , <br /> iLUMlING MECHANICAL <br /> NO. T'PE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT PEE ' <br /> WATER C�OSET�TOIIET) A/C—A/HNOLG UNITS—H.P. i�. <br /> BATMTUB � REFRIGEHATION UNITS—HP.EA. �. <br /> UVATORV(WASM B�SIN� BOIlEPS—BSL./H P. <br /> SHOWER GAS FlREO A C.UNITS—BS.U. <br /> KITCHEN S�NK i OISP. FORCED AIH SYSTEMS—B.T U. M EA. <br /> DISHWASMER WALLHEA7ER5—B.T.U. M � <br /> UUNDRV TR�V UNIT MEATERS—B.T.U. M � <br /> CLOTNES WASMER EVAPORATIVE COOLERS " <br /> URINAL CLOTNESORYEHS <br /> ORINKING FOUNTAIN VENTILATION FAN <br /> FIOOR ORAIN RANGE HOOD ' <br /> BACKFIOW M7EVENTERS WATER HEATER <br /> ROOF DNAINS—RAINLEADERS WOOD SiOVE + <br /> SINK�SERVICE—BnR.ETC 1 METAL FIREPLACE 6 CHIMNEV <br />. FIREPIAGE INSERT <br /> HEATPUMP <br /> GAS PIPINO <br /> E%NAUSTFAN <br /> fUlTOTAI � SUBTOTAL <br /> PERMIT ! PERMIT <br /> TOTALFEE ! TOTALFEE <br /> f RONT SEiB�CN f1E�R SETB�f.R SIOE SETB�CK PLAN CMECK NUMBER FEE RECEIPT NO. <br /> usezone ��T�RE� wceNtsrc� FEES VALUATON FEE <br /> ores oNo <br /> OUILDING S <br /> TYPEOfCONST pCCIIPANCYGROUP NO.OFOWELLINGUNITS <br /> PLUMBING <br /> 512EOFBlDG NOOFSIONIES MAX.00G.LOAD <br /> MECMANICAL <br /> OTHER <br /> FIFE SPRINHIEFS REDUIREO ❑YES O NO STATE BUILDING SURCMARGE <br /> STATEENERGVSURCHARGE <br /> AVPLIGiIONACCBY PL�NSCIIEGNEDBY �PPRFORISSWNCEBY <br /> PUBLIG WORKS <br /> TOTAL <br /> PROPERTYOWNERS ARE RESPONSIBLE FOR DETEFlMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />