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. .PPLICATION FO�. ' <br /> '�""'°"'" CO N STR U CT 1 O N �`�`°" <br /> un a <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259•87a5 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑COMBINATION Q BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNER M�II�DDRESS L IP PHONE <br /> �,,,�, � � �.��s 3�z �141��, �9 ,�� ���� � � �� �s��� <br /> •PCNItECfOR0E910NER M�ILAOORE93 Cltt ZIP PNONE <br /> OENER�LGONiH�CfOR MAIL�OORE55 GIIY 21P PHONE IILENSE• <br /> MECII�NIC�LCONiR�CTOq MMLAODRESS CIiY 21P eNONE �iCENSE• <br /> � VlUM91NOCONIR�CfOR M�IL1100RESS CITY 21P P�IONE UCENSC• <br /> CUSS Oi WORK �,�/ <br /> ❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION .I�[ WOODSiOVE/FRPL.INSERT ❑ BUILDING RE�OCATIUN <br /> V�lWTIONOiWORR�CO fM�IERI�lSGLUSL�BOPo <br /> bb <br /> DESCRIeE W0� ^ � ^ � /� � /7 <br /> �C{i_. l J CXL�1 Ci.C�( r <br /> ' USEOiBWl01N0 � <br /> I HEREBY CERTIFY THqT I HAVE REAO AND EXAMINF.D THIS AP• <br /> ! � `�R PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.AIL <br /> �� �ea�� ESCP�PTIONOFPPOPERfY�9NOWNBELOWOR�R�CHFOURCOPIES� pROVISION50FLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> • �or_e�oc�—ov 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 OR LOCAL LAW REG ULATIN6 CONSTRUCTION <br /> S OR THE PERFORMANCE OF CONSTRUCTION. <br /> � SION�TURE OF ONTRACTOR OR AUTNORI2ED AGENT D�TE <br /> X "., � ��/� <br /> PHOJECT�DDNEl9 APPUC NTS CITY NESS UCENSE NO. <br /> ✓W O <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIIfiUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET iOIlET) AIR COND.UNITS—H.P.EA. <br /> BATHTUB REFRIGERATION UNITS—H.P.EA. <br /> IAVATORY�WASH BASIN) BOILERS—H.P.EA. <br /> SHOWER QAS FIRED AC.UNITS—TONNAGE EA <br /> KITCHEN SINK6 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> UISHWA3HER WALL HEATERS—B.T.U. M <br /> LAUNORVTR�Y UNITHEATEFS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVECOOLERS <br /> WATER HEATER CLO7ME5 DRVERS <br /> URINAL VENTILATION FAN <br /> DRINKINO FOUNTAIN RANGE HOOD <br /> FLOOR DRRIN AIR HANDUNG UNI7— GF.M. <br /> VACUUM BREANERS STOVE � <br /> ROOF DMINS—PAINLEAOEfl3 METAL FIREPLACE 8 CHIMNEV <br /> SINKISERVICE—B�R,ETC. WOOOSTOVE/FIREPLACE INSERT <br /> SUBTOTAL 9UBTOTAL S <br /> PENMIT t PERMIT 3 <br /> __ TOTALFEE t TOTALFEE ! <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONT5EIB�CK RE�NSEiB�CK SIDESEIB�GN PLANGHECKNUMBEP P�ANCIIECNIEE <br /> iEE RECEIPTNO <br /> USE 20NE lOf�IIEA y1CANT SITE — <br /> � OYES ONO FEES V�LUITION FEE <br /> IYPEOFCONST. OCCUP�NCYCHOUP NO.OFDWELlINOUNlT3 <br /> BUILOINO f <br /> S12E Oi B100. N0.Of St0f11E3 MAK OCC,10�� <br /> PLUMBINO <br /> MECMRNICAL <br /> FIPE SPRINKLERS REOUIRED ❑VES ❑NO <br /> OTHER <br /> PENALTY <br /> �VPLICMION�CG BY PLANS CNECRE�BY APPR.FCR ISSUANLE BY _ <br /> .A TOTAL <br /> � /' - � <br />