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,ME»ro„,� - .PPLICATION FO,. ���,�„ <br /> ��^�°� CONSTRUCTION <br /> everett P E R M I T e <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION �8'BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEN M�II Appil[ti5 f.IfY ZiP PIIONB <br /> �bNw�.o I�El�iirl(�E�'_ 100 O14KS EUE�ETT �18xo/ z52- !�/75 <br /> �NCNITECTOROk51ONER MALAODIIG55 CIIV (IP VIIONC <br /> �QWuSbN UxllTE1� �3rJ"18/yr �L.�W !_yNNU� J`�037 778- l/l�0 <br /> GENEPAL CONTFAGION MAII p[1pRES5 CItY ZIP PI�ONE tICENSE• <br /> 8�2au5�,�J uwiTE+O �1s ,��gouE 8e�aersixz �4�� <br /> MEf.11�NIC�L CONTN�f.IOq MMI �pppC55 GIY tIP PIION[ IIGENSE• <br /> PIUMBING CONTPACIOR M�II AD�BC55 CITY 21P PIIONE IILENSC• <br /> �G SS OF WONN <br /> NEW ADDITION ❑ A�iERATION ❑ REPAIF ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�IU TIONOFWONK�COSTOFM�TERI�LSPLUSL�BOfl� <br /> ��JSOC� �' <br /> DESCRiBE WONK <br /> Nsr c. a x 14 � uI� ��v <br /> use ov em�mN� <br /> �p�� I HEREBY CEFTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br /> PLICATION AND K NO W TH E SAM E TO 8E TRUE AND CORqECT.ALL <br /> LE��LOESCRIPTIO.JOFPROPERTY�SMOWNBEtOWON�TT�C11FOlIRGOPiE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> I N �L QA' p�f" OFWOliKWILLBECOMPLETEDWITHWHETHEHSPECIFIEDHERE• <br /> �or_e�ocK_or IN OR NOT.THE GRANTING OP A PERMIT DOES NOT PRESUME TO <br /> Z7M- I BE.C'� NW GO�C �,�J� /�(,�J � GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br /> C OR THE PERFORMANCE OF CONSTRUCTION. <br /> � ' 4qI �O' r� �� O ��• SIGNA7UR' 1'CpN7R�Ci0 RAU�IIOPILfDAGENi OATE <br /> rv,� nv.�. �oFr. �u. E. i � .N.so F-r, X 4 vs e� <br /> PPOJECT110DPE55 � � ',+ APPLICANiSGITY0U51NE55lICEN5EN0 <br /> / <br /> 00 O �K5 EuPa!� <br /> �LUM�IN6 MECHANICAL �I <br /> NO. TYPE Of FIXTURE FEE NO. 7VpE OF EOUIPMENT FEE <br /> _ WATER CLOSETITOILET) __ AIR COND. UNITS—HP.EA <br /> BATHTUB _ REFRIGEHATION UNITS—II P. EA <br /> LAVATORV�WASHBASIN� BOILERS—fIP EA. <br /> SHOWER GAS FIRED A.C. UNITS—TONNAGE EA <br /> _ KITCHEN SINK 8 OISP. FORCED AIR SYSTEMS—BS.U. M EA <br /> OISHWASMER WALLIIEATEHS—BS.U. M <br /> LAUNDRYTRAV UNITNEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLEFS <br /> WATER HEATEH CLOTHES DRVERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOIINTAIN RANGE HOOD <br /> PLOOR DRAIN Alq MANDLING UNIT— CF.M. <br /> VACUUM BREAKEHS STOVE <br /> ROOF DRAINS—RAWLEADERS METAL FIREPUCE 8 CHIMNEV <br /> SINK�SERVICE—BAR,ETC. WOODSTOVE/FIqEPLACE INSERT <br /> — . _— _ —_'_ � <br /> '___ __'_ __ '— ___'_ _ _ ( <br /> —_'_'—" ____ ___—_ I <br /> ___ 8UB TOTAL '_—'_—._ __�__'— _'__ "_—" SOB TOT�L —____=i ____�' "__ <br /> PERMIT __'___' S ___—'_ '_ _'_'__' "_ PEHMIT _'___'__ t — — <br /> _ '_ __" _'_ <br /> " <br /> _" _'_"".—'_" TOT�LFEE "_ ___'_"f " _._..___" _'_ ' _' _ '. ___ '_"___"TOTALFEE ._.. __ ____ ' <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iROMSETB�GN RE�RSEIB�CK SIOESETBACK PUNCIyIEGK/NIIAIOEH ^ �r PI�NGI�ECKiEE <br /> �� U / ta� �J, � � �S � I / I�r5`y fEE `��`� HECEIPTND 4'�,/_ /S <br /> � ( � !,'c�0 <br /> USE20NE IOTARE� ,/ y�CANI5IIE <br /> 1 ���J(J�) ry� OYES �NO FEES V�LWTION FEE <br /> ��;. <br /> TYPEOFGONST OCCl1P�NGYGNOOP NOOFDIVEIlING11NIT5 S� <br /> �� M�� f' euaoiNc s �j SOU 4' 8l. C`ij�J <br /> S12E OF OLDO NO OF STOPIES MA% OCG IOAp <br /> 5 �� ( N � PLUMBING <br /> MECMANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ YES NO � <br /> OIIIER �G C <br /> PENALTY <br /> �VPI.iC�f10N�Cf. OY PLANSf.11BCHED OY APPR FOq ISSII�NCG�Y --.—_ — � — `-1 <br /> � TOTQ _ -_ _ � SV <br /> .�1 r�_ � -� . <br />