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��.E�ro,»� ��PPLICATION Fa,.;' <br /> ""°° CONSTRUCTION <br /> ��«�„ <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL <br /> Ow1lEH ❑ PLUMBING ❑SIGN <br /> ���� � MMI�ODRESS CI1V <br /> CA�V� � L :�/S C/�///'LNTE �( Z1P �'CMONE <br /> �RCHIECIOROESONER � "'o ���� 9�z ya /�yQ ��Q <br /> M�IL AOOPESS C�n, <br /> 21P �IIONE <br /> GfNEN�LCONiR�CIOq M�IIppDRE55 <br /> �J ��TM Z�P PHONE <br /> � A CAN�L L /S CA/f/'�iYTE�/ D LICENSE. <br /> �MEC �(NIWLLONiR �TOq M�ILADDRESS ` /� SNO/y ��J�O •j� //- �l`OO � <br /> cm � a <br /> Z�P PIIONE <br /> LICENSE• <br /> PLl1MBINOGONIpAGIOR M�I��DORE55 <br /> Cltt ZIP PIIONE <br /> IICENSE• <br /> C1�S50F WORK <br /> ❑ NEW ❑ ADOITION ❑ ALTERATION � REPAIR ❑ DEMOLITION ❑ <br /> ��LU�TIONOFWORN�COStOFM�iEqip�5PLU5L� qi �NOODSTOVE/FRPL,INSEqT ❑ BUILDING RELOCATION <br /> —��'1v-�z.���'� ��.� o GD <br /> DESCq BE WONK <br /> - � �3/.� L '�i4- <br /> USE pOF BUIIDING <br /> T �! ` Tj� I HEREBY CERiIFY THAT 1 HAVE READ AND EXAMINED THIS Ap• � <br /> IEO�LDESCRIPf10NOFPqOPERfY�SHOWNBEIOWOR�iTACHFOURCOPIES� P��CATIONANDKNOWTHESAMI_TOBETRUEANDCORRECT.ALI <br /> � PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> �or_e�ocK_or OF WORK WILL BE COMPLETED�NITH WHETHER SPECIFIED HERE- <br /> IN OR NOT.THE GRqNTING OFA PERMIT DOES NOT PRESUME TO <br /> 2 „�� GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCqL LAW REGULATING CONSTRUCTION <br /> » p L � 7 A/ �' C r � OR THE PERFORMANCE OF CONSTRUCTION. <br /> �L�'T� !)�a `,�f� SIONATUREOFCONTRACiORORAUTHORIZEDAGENT <br /> �(`C�� /Yd aaa 9a, - � - � DATE <br /> � a � � �' � � �' � z <br /> PROJEGTAD�RE55 �o • <br /> �on 3 � L�li r/� lI 1� /� APPLICANi Y BUSINE59 4CENSE Np. � <br /> � �i � � <br /> IUMB�N6 ' <br /> q , MECHANICAL � <br /> TYPE OF FI%TURE FEE Np, I <br /> WATER CLOSET(TOILEn T�'PE OF EOUIPMENT FEE I <br /> BATHTUB A�A COND.UNITS—H,P.EA. I <br /> LAVATORV�WASH BASINI REFRIGERATION UNITS—Il.p,Ep, <br /> SHOWER BOILERS—H.P.EA. <br /> KITCHEN SINK d DISP. GAS FIRED AC.UNITS—TONNAGE EA <br /> DISHWASHER FORCED AIR SVSTEMS—�.T.U. M EA. <br /> LAUN�RY TRAY h'A��HEA7ERS—B.T.U. M <br /> CLOTHESWASHER UNITHEATERS—B.T.U. M <br /> � WATEF HEATER EVAPORATIVE COOLERS <br /> URINAL CLO7HES DRYERS <br /> DRINKIr1G FOUNiA1N VENTfLbTION FAN <br /> FLOOR DFAIN AANGE HqO� <br /> VACUUM B(iEAKERS AIR HANULING UNIT— C.F.M. <br /> ROOFDRCI4S—HYMLEADERS STOVE <br /> SINK�SERVICE—BAR,ETC. ME7AL FIpEPLACE R CHIMNEY <br /> WOODSTOVE/FIRENIACEINSERT ' <br /> � <br /> 5119 TOTAI <br /> PEpMIT s SUB TOTAL s � -- <br /> — TOTALFEE f PEPMIT = <br /> TOTALFEE S S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> TSEIBApK RE�RSEiBACY. SIqESETBA�g <br /> PLAN CNECR NUMBER PI�N CIIEGK FEE <br /> ONE LOf�RE� FEE IRECEIPINO. <br /> V�C�NT SITE <br /> OYES ONO FEES VALU�TION FEE <br /> �F�ONSi. OCCUPRNGYGPOUP NO.OFpWELLINGUNli3 <br /> 'O100 NOAf S10R�E3 Mq%,OCC.IORD BIlIL01N6 f ia ac a ��S Q o <br /> PLUMBING <br /> iPRINKLERS REOUIRED O VES O NO MECHANICAL <br /> OTHEfl <br /> �tIONPCG OY PlRN5C11ECKEDBY MPR.FOOISSUPNCEBY PENALTY <br /> �/��, ,I� 1 TOTAL - <br /> V� <br />