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M�Ererprron �O����O�'O� � everetl <br /> CIiY OF <br /> e�erett PERMIT e <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. � � �f�� <br /> 259•8745 ❑ COMBINA,TION �" BUILDING ❑ MECHANICAL I� pLUM81NG ❑ SIGN <br /> OWNER ♦ �IAI�ApORE55 �IiY JIP pppryr <br /> f;��� �— i,��,e�9��> �sis C.eYSPN'r1/G�- �-l��Fe�r�� �.����� ,�;.� s�o <br /> RFCNILECTOROESIGNER MAILAOORESS C1V 21� P1101![ <br /> GEN[RALCONiR4Ci0R FI�II.AOORESS Clrv Fv���—/y�p� � �1�� piipryE ��� ��SE� <br /> r/ <br /> C��'unrOqif� ��A•Fsoni c�n�s % ��c . �iyis 6or,iPi/ ui�s� 3.f>s�i>ti �2�� �c id�� <br /> MECHRNICQGpNTqR�Tp MAI�q00RE55 CIl' P��ONE IICENSEr <br /> VUIM9INOCONTNACiOR MML��ORE55 CIiY 2iP PHONE LIGENSE• <br /> C1�S50i WONK <br /> ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERi ❑ BUILDING RELOCATION <br /> VRL W IION OF WORH(COSi OF M�iERI'1L5 P W 5 UBOR� <br /> �I l�� <br /> DESCmBEWO�N <br /> � ' C� � X .3C� ' <br /> USE O�BWLDMG <br /> � ���� I HEREBY CERTIFY THAT I HAVE READ AN� F.XAMINEO THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT.ALL <br /> �ewiocscniariono�PERtV1540WNBELOWORATT�CIIFOURGOPiGS� PROVISIONSOFLAWSANDOROINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SP�CIFIED HERE• <br /> �oT eioc � ov e � � INORNOT.ThiEGRANTINGOFAPERMITDOESNOTPRESUNETO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTtiER STATE OR LOCAI LAW REGULATING CONSTRUCTION <br /> OR Th1E PERFORMANCE F CONSTRUC110N. <br /> SIGNA1UIiEOP ONTRACiOR iAUiHO�IZEqAC N 0lIE <br /> / <br /> � -' � / /� 0 -/ _ �' - <br /> PROJECTAODRE55 APPUC�NiS'UTPOUSRlE55lICEN5EN0 / <br /> Ysa ° <br /> GLUMBINO MECMANICAL <br /> NO. TVPE OF FI%TURE FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CIOSET�TOILET) - L� AIR COND.UNIiS-H.P.EA. <br /> I OATHTUB '�Q�O� REFRIGERATION UNITS-H.P. EA. _ __ <br /> LAVATOHY(WASH BASIN) [y(/ DOILERS-H P.EA. <br /> SH0IYER U GAS FIRED AC.UNITS-TONNAGE EA <br /> NITCHF.N SINK 8 DISP. FOliCED AIR SYS�EA15-B.T.U. hl EA. <br /> DISHWASHER WALL HEATERS-[7.T.U. h1 <br /> LAUNDRVTRAV UNI7HEAIERS-B.CU. M <br /> CLO7MES 1YASHER EVAPORATIVE COOLERS <br /> WATER HEAiER CLOTHES DRYERS <br /> URINAL yENTILATION FAN � <br /> ORINKING FOUNTAIN qANGE HOOD <br /> FIOOR DRAIN AIR IIANDLING UNIT- C.F1A. <br /> VACUUM BREAKERS SiOVE <br /> ROOF DRAINS-RAINLEADERS MEtAL FIREPLACE 8 CHII.7NEV <br /> S�NK SERVICE-BAR,ETC. WOODSTOVE/FIREPLAGEINSERi ' <br /> SUBTOTAL (� SUB70TAL 5 O� ' <br /> PERMIT S �- PERMIT S <br /> _ TOTAL FEE S t_(J TOTAL FEE S 0 ; <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL ; <br /> iRONfSEIUACN AEAqSEIBRCK SIDESETBACH PUNCMEGHNUMOER PIaNCUF.CKfEB <br /> 2 oF� �c�r-r r.�� �v � a s � �E�1 ` „«��,;��o o� <br /> USE20N[ IOTARE� yp�qNT51TE <br /> YJ,�/ �YES pN6 FEES VAlUFT10N FEE � . <br /> �l <br /> TYPEOFCON�I ���`YOROUP � NO.OFOWELIINGUNITS � <br /> V v � 9UILDING 520�,� /L�� .rJ-� ! <br /> 54EOFBLDO NO.OFSTOnIE9 MAXOCCLOAO � <br /> AbGJ Gao 5.F � �,1,y PWMOING <br /> � �a ; <br /> � / MECHANICAL 3 �d ` <br /> FIRE SPRINKLERS REOUIRED ❑VES m'NO � <br /> OTMER <br /> - t <br /> PENALTY <br /> APPUCA710N�GC.OY VlANSGHECKEOBY APPq FORISSUANCEOY ` � <br /> L . G TOTRL �S/ J—D i <br /> � � ��n � , <br /> � <br /> ) � <br /> %i�i�-t.c-e.v��<. f'- u-�-�,.. . <br /> ( ` ✓ <br /> i <br /> 1 <br />