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� °ryE°rom� � CONSTR C TION� `""`" <br /> ' eVerett Pf RMIT P+ <br /> � BUILOING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ dUILUING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> ,- OWNER � M�II.AOD(IES_ ' Cltt ZIP PIIONE <br /> /;? , '.i ll.� ,, ,.,<< ..:•rj' ,' �,� >i � ',' ,(..;. , f: e?- . �y -- ;� 3 �r 1 <br /> � �F HIT CTOItDESIGNEN � M�II.�DDflE55 GITY �/�i �`� �p�p PtlONE <br /> �, „!� /�„ �.; ��' <br /> G�ER�LGONTH�O�pq�� ' � MMLApDflE55 CIT� ZIP PIIONE IICENSE� <br /> MECH�NICQ CONiR�CTOq MMl�D�A[55 GITY 21P PNONE LICENSE/ <br /> PIUMBINGCONTR�CTOR MMl�D�PESS d7Y IIP PIIONE uGENSE• • <br /> CUSS OF WORK - <br /> ❑ NEW ❑ ADDITION � ALTERATION ❑ flEPAIR ❑ DEMOLITIOIJ ❑ WOODSTOVE/FRPL.INSERT ❑ BU�LDING RELOCATION � <br /> V� Nr�OF.yWO+�RN�LOSTOiM�TERULSPlUSI� <br /> ( r77.7i� .� .e- �� L: r ��i ' 9 - .�1., �F _� $ f <br /> �l!/ y <br /> DESGpIBE WORN �—� � �J ) 1 <br /> �, � , t.,,�y� F. ,� � y, �,..��, .�y,.�. ,.- .�., , __ <br /> 9. i � � <br /> u wimNc <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BETRUEANDCORRECT.ALL <br /> IEO�LDE IPTICNOFPpOPFRTY�SMOWNBEIOWOfl�TTAG11FOlIRLOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> �o%ye�oc��or ��'� � � °6�� OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> ,t�, n GI ERA�HOR TYTON 10 A�TE OR CANICELOTHE�ROVISIONS O� � � <br /> 1 /_G�[? f�[ r— �/iu � �) /J/ � . • • ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> .i OR THE PERFORMANCE OF CONSTRUCTION. <br /> r � •i <br /> :T� .���� j � < . ' SIGN�IURE Oh CONiRACTON OR�llii ORIIED�GENT U�TE ' <br /> ' � � I <br /> t� �^. 1 . L � � /� �Y•• J'�� <br /> PPOJECT1pDRE55 f �PPt�GNiSGIlY011SIN[SStIL[NSENO � <br /> � �o � y (-�)., .�_<, ' <br /> PLUMlINO MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OP EOUIPMENT FEE <br /> _ WATERCLOSET�TOLLE AIRCOND. UIJITS-H.P, EA. <br /> BATHTUB REFRIGERATION UNITS-H.P.EA. ,. <br /> LAVATORVIWASH BASIN� BOILEFS-M.P.EA. ' <br /> SNOWEH GAS FIRED AC. UNITS-TOkNAGE EA. <br /> KITCHEN SINN 8 OISP. FORCED AIR SYSTEMS-B.T.U. M EA. <br /> DISMWASHER WALL HEATERS-B.L.U. M <br /> LAUNORVTRAV UNITMEATEflS-BS.U. M <br /> CLOTHES WASHER EVAPORATIVECOOLERS <br /> WATER HEATEF CI.OTMCS DRYERS <br /> 11RINAL VENTILATION FAN <br /> ORINKIN6 FOUNTAIN pqNGE HO00 , <br /> FLOOR DRAIN AIR HANDLING UMT- GF.M. ' <br /> VACUUM BREAKERS STOVE <br /> ROOF DR�INS-HAINLEADERS METAL FIREPLACE 8 CNIMNEY ' <br /> SINK SERVICE-BAR,ETC.) WOODSTOVE/FIREPLACEINSERi <br /> BUB TOT�L SUB TOTAL f <br /> PERMIT f PERMIT i <br /> __ TO7ALFEE i TOTALFEE f � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONTSETB�CN REARSEtB�CK SIDESETB�CN PL�NLHECNNUFIBER PL�NGI�ECNiEE � <br /> FEE RECEIPiNO � <br /> USE20NE �OTARE� ' <br /> VAf,�Ni51TE FEES VAlUAT10N FEE <br /> ❑YES ONO <br /> P `EOFLONST. OCCUPeNCYGROUP NOOF�WELLINGUNITS ' <br /> E3UILOING S <br /> 512E OF OlDO NO OF STORI[5 M�% OCC tOeD ' <br /> PLUMBING <br /> MECIIANICAI � <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑ NO <br /> Oi11ER <br /> PENALTY <br /> APPtIC�iIONACG 9Y PLANSCHECKEDBY pPPR FORISSU�NCFBV <br /> . ,,-. TOTAL <br /> i ' <br />