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. .PPLICATION FO. ���,�„ <br /> IMEwryrNn CONSTRUCTION <br /> �,n� e <br /> everett PE RM IT <br /> BUILDINC DEPARTMENT <br /> 259•e745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ,1�MECHANICAL ❑ PLUMBIN(3 ❑ SIQN <br /> OWNER . MAllAD011E53 CITY 2iP PHONE <br /> I/ �� � � �� I � ���� 1 �+ ^I ' <br /> �RCHIIEG UE41 EA M�II�DOflE39 CIIY ZIP PNONE <br /> QENEP�IGONIR�CION MML�ODNE55 CIIY 2iP PNONE UCENSE• <br /> MECN�NIC�LCOHiR�CTOq M�IL�DORE55 CRY 21P P���qNf LiCCNSF• <br /> �1.0 �`� �, ��•J IlaTra L Illw��,�o U,^�u) llv�. y�;�Dl �,55-�J�4al ►U�7tt�� ' �3-all� - <br /> PL MBINOLONiR��fOR M�IL�DDRE55 GItY ZIP PIIONE IiLENSE• <br /> CUSSOf WORN <br /> ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVEIFRPL.INSERT ❑ BU�LDING RELOCATION <br /> V�I W f10N Of WORR ILOST OF M�IENULS VlUS UBONI <br /> OESCRIBE WORR � <br /> C ci� z wri . � ' <br /> us[I WIDI <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP� <br /> �.`� CR..i PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.AIL <br /> �ea�tc SC��PIIONOFPROPENIY�SNOWNBELOWORAII�CNFOURCOP1E51 PROVISIONSOPLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HtRE• <br /> ior_e�oc�—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONS7RUCTION. <br /> SIGNATURE OF CONiRACTOR OR AUTNORqED nGENi DAiE <br /> X� 1�.� L '� � l�- la-6 I <br /> VROJECI�OORESS �PV�ICA 1'SC�IYB 'IN[SS:ICENSEND <br /> � �G.Y <br /> PLUMBINO MECHANICAL <br /> NO. TYFE OF FIXTURE FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) AIP CONO.UNI15—H.P.EA. <br /> B�THTUB REFRIGERATION UNITS—H.P.EA <br /> LAVATORVIWASHBASIN� BOILERS—H.P EA. <br /> SHOWER GAS FIRED AC. UNITS—TONNAGE EA <br /> KITCHEN SINN d DISP. FORCED AIR SYSTEMS—B.1.U. M EA. <br /> OISHW�SHER WALL HEAiERS—B.T.U. M <br /> LAUNDRY TRAV UNIT HEATERS—B.1.U. M _ <br /> LIOTHES W�SHER EVAPORATIVE COOLERS <br /> {y��q CLOTMES Df7YER5 <br /> UR�NAL VENTILATION FAN <br /> DRINKING FOUNIAIN RANGE HOOD _ <br /> FLOOR ORAIN AIR HANDLING UNI7— QF.M. _ _ <br /> VACUUM BREAKERS STOVE _ <br /> ROOF DRAINS—R�INLEADERS METAL FIREPLACE A CHIMNEY <br /> SINN�SERVICE—BAR.ETC. WOODSTOVE/FIREPLACEINSERT <br /> Wme� II� -re <br /> 3UBTOTAL SUB TOTAL 3 <br /> PERMIT f PERMIT 3 <br /> TO7ALFEE ! TOTALFEE 1 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNE:L <br /> fHONiSEIB�C1t IIE�RSEIB�CN SIOESETB�LK PL�NCHECNNUMBEN PI�NCUECKiEE <br /> iEE �ECEIPI NO <br /> USE ZONE tOt AHE� yAC�NT S11E <br /> FEES V�LUIITION FEE <br /> ClYES ONO <br /> fYPEOfLONSi OCCUP�NCYGROUP NOAFpWELLIN6UNIT5 <br /> BUILDING S <br /> 512E O�6100 NO Oi 9URIE5 MA%OCC LOAO <br /> PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS RE�UIRED ❑YES ❑NO <br /> OTNER <br /> PENALTY <br /> APPl�C�110N�GGBY VUNSC��ECNEDBY �PPR,�ORISSU�NCEBV <br /> TOTAL <br />