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`�,-iPPLICATION f O►� ��«<n <br /> �^.E~'°'"" CONSTRUCTION � <br /> cin oF <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COM8INATION � BUILDINCi [� MECHANICAL � PLUMBING ❑ SIGN <br /> ea eooness cirv nv v�wr+e <br /> ° � n k �Ff✓i��'�3 3���ri <br /> � � ci zir r��oHc <br /> �(1f111 FCiO�DE5IONER ,�/ /�IAILADDRESS <br /> Y <br /> �,I'��V/\ � � �� �r �/ <br /> M�IL�ORESS CItY ZIP P110NE LICENSE <br /> OENC�AICONiP�CTOR / ` . / L ��(,� J� <br /> � , f-A � S � � <br /> M�IL 0�55 � l CI7Y ZIP PBONE LIC[NSE• <br /> MEGII Nlr�l CONtR�CIOfl � �, l ,�11� � ( )) !'�/S� <br /> � J <br /> � �� 21P PMONE LILCNS[• <br /> p pv iC[l�l1 � 10 " MRIy�D ES <br /> ���"�Zh�i'� �� �+ �� !I <br /> C SSOf WORR <br /> ❑ NEW � ADDITION ❑ ALiERA710N ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> MIU���ONO�WUIIK�GOSf01 MAICOI�LSPLUSU�0�1 ���� <br /> �di[�Hp�1��E��,/1 ���� <br /> s�mE wonK <br /> /� �� <br /> seoruuaou+c,_ ,�1�•� llls'�L�.SS� �� I HEREBY CERTIFY THAT� HAV READ AND EXAMINED THIS AP- <br /> III��/�IiI.YNG71� /A•fC!S NY " �� ' '" PUCATIONANDKNOWTHESA ETOBETRUEANDCORRECT.ALL <br /> t[G�LDESCR�PtIONOFPIIOPEf11Y15NOWN8ElOWORRTT�CMiOUfiLOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> .�, OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> �/�/✓�� ..1 � 1 �.e - INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO. <br /> `�"_f'""'i°�N '� °F GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUC7�ON <br /> •��/%i/J/� � OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF WN7fiACTOR OR AUTMO �D AOENT OAiE <br /> X t GC <br /> �pp� PNTSGIIYPUSIN IGE S NO. <br /> Pt10JEC1�ODIlE55 / /,� <br /> /I�I� � r1�II�/• � '���I �' / � �� MECHANICAL — <br /> PLUMBIN6 7ypE OF EOUIPMENT FEE <br /> HO. TYPE OF FIXTURE FEE NO. <br /> WAiER CLOSET(TOILEn LL� A�Fi COND.UNITS—H.P.E0. <br /> REfRIGEFATION UNITS—H.P.EA. <br /> BATHTUB � BOIIERS—H.P.EA <br /> LAVATORv(`�'ASH BASIN) �D GAS FIRED 0.Q UNITS—TONNAGE EA. -- <br /> SHOWER FORCED AIR SVSTEMS—B.T.U. M EA. —� <br /> KI�CHEN SWKB DISP. , _ <br /> WALI HEATERS—B.T.U. M <br /> DISHWASHER UNIiHEATERS—B.T.U. M � <br /> LAUNDRVTRAV EVAPORATNECOOLERS --- <br /> CLOTHES WASFIER CLOTHES DRVERS <br /> W�TER HEATEH �� <br /> I VENTILATION FAN — <br /> URINAL pqNGE HOOD <br /> OHINKING FOUNTAIN AIR HpNDLING UNIT— C.F.M. <br /> FLOOR DRAIN STOVE <br /> VACUUM B(IEAKEPS METAL FIREPLACE 8 CHIMNEY — <br /> � ROOF DRAINS—R�INLEADERS �L <br /> SINN SEFVICE—BAP,ETC. WOODSTOVE/FIREPLACE INSERT -- <br /> — �. J .. <br /> SUB TOTAL s ��� � <br /> SUBTOTAL pERMIi s <br /> PERMIi s TOTAL FEE : --��� <br /> TOTALFEE s � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL — <br /> p�qN GMECK NUAIBER ,e� <br /> p�pN CHECK fCE <br /> IIIONISEIOALN p[RPSEIOACK SIOESEIO�CK �/ ��� FEE�^�� �«��5���� <br /> 2os� 2o�-s �r= �� ° <br /> IOiARU VRLU�TION fEE <br /> USE IONE WCTNT SIfE FEES <br /> />Jr OYES F�f7� —_ <br /> /!r 1 <br /> nrcorcor+si occur��icvcr�ouP NO.OFOWELLIN6UNIIS <br /> .� � 2�3 - auaoiNc S�� �Z � <br /> siLE or flioG 110.OF SfOPIES MAK Oca LOeD L <br /> I PLUMBING <br /> MGCIIANICA� IO C <br /> FIRE SPRINKLERS REOUIfiED ❑VES O NO OTHER <br /> PENAL7Y <br /> �PPUC���ON ACG OY PL���S CIIECNED OY �PPti.FOO ISSU�NGE BY /OR � <br /> TOTAL �� � <br /> �� G . G, <br />