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��.E»,o,�� t•PPLICATION FC;� <br /> "tt°` CONSTRUCT�ON <br /> everett °�e <br /> PERMIT <br /> BUILDING DEPT. TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br /> 259•8745 <br /> / ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ pWMBING ❑ SIGN <br /> OWN <br /> ,/( /�M/�IL��DF155 <br /> : :: l:t�f GLr�1/ �//A� /f�lC� ./�y'.��a�.;C/ C:' cin `a PHONE f <br /> acHirc aoesicHcn isli . lC� �ilF..f`Ycs< /n/6 .�Y�.�i��G� Jy2-G�4C <br /> MAi��OORESS <br /> f �� C111 21P <br /> PMGNE <br /> GENERAI.L�NiN1�fOR <br /> MqL ADpNESS <br /> C> �`_'_l t.r. . --,_._. C�iY IiP PNONE <br /> MECHeNIC �pryiq� pq �CENSE• <br /> _ M�IIADOPF55 2�'g-c.� -�y�-L <br /> •- � . "' ' -- .� Glry ZIP PNONE <br /> PL�IABING NIBApJO� —_ ��CENSE• � <br /> ��� �qApDqESS <br /> . ":�„ CI1Y iIP PHONE <br /> LL SS Oi WORR � ./L 1 . �[. /l. ,(J/ L HSE• <br /> ❑ NEIY ❑ ADDITION L� " '� UZ' �/" [� � <br /> fI-nLTERATIO �IEPAIR ❑ DEMOLITION �"l�/ � <br /> WLWiIONUfWORK�CO510FMAtCqUI$Cl.Uti[ABOqI � �'dOODSTOVE/FRPLINSERT <br /> !'" ❑ BUILDING FELOCAiiON <br /> •_� ('•(L(r, ��._ <br /> oes i c wpnrc i •• <br /> (.c ;.���(�..� -. !. � . .c CC: c.� ��Cl.c r( � <br /> us[oveunou„ / , � , �,�� .7 <br /> �� / � <br /> r✓ �� J-�'�z�-{'_-t .�,,..f ' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS Ap• y � <br /> IfG�LUESCRIPIIONOFPpOPERfY;5110WNN[lOWpqATTAp�FOURCOPI 5�- PLICATIONANbKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVpE ~ � <br /> ��r�'a10�'"---0� OFWORKWILLBECOMPLETEDWIiMWHETHERSPECIFIEDHERE• �Q <br /> / 1 � � • / IN OR NOT.THE GRA TING OFA PERMITDOES NOTPRESUME TO t`j+ <br /> � �- �r 7 • • �✓�`�+ �C F:'�� GIVE AUTHORITY T�VIOLATE OR CANCEL THE PqOVISIONS OF y <br /> ANYOTHER STAT�.OR LOCAL LAW REGULATINGCONSTRUCTION O � <br /> =-i' ;�;f.' � / ' J OR THE PERFOqMANCE AP CONSTRUCTION. �] <br /> � �', ��L K� �I �% �"f^ SIGN�TURFOFCy�iRAC�TOR AUiMORIZE �GENT D�TE .T a <br /> / 7� X / / �� � �' ~ <br /> ��.r/r'/i�i/= f �/J /�c ,7(!(% z <br /> raaEcteooa¢ss �'- <br /> � � ���. �/',� ['�f� " 't�'L"' gu{�N s ' �L� � � � <br /> � C�-' <br /> J � ~ <br /> PLIJMSuINO tA <br /> NO. TYPE OF FIRTUPE MECMANICAL � � <br /> WATERCI.OSET�iOI�E__�__�_— FEE N0. 7VPEOFEOUIPMENT <br /> BATNTl1B �IR COND UNITS-M P EA. FEE � <br /> UVATOHV�WASH bASIN� AEFRIGEHATION UNITS-N P.EA. N <br /> SHOWER BOILERS-HP EA. r['� <br /> , KITCHEN SR�K d DISP. GAS FIRED A C UNITS-TONNAGE EA � <br /> �OISH WASHE FOflCED AIR SYSTEMS-B T U. M EA. <br /> �_ LAUNDRYTpA---y --�- WALLNEATERS-BT.U. M • � <br /> CLOiNES WASN[R UNITHEATEqS-BTL. M <br /> WATEH HEAiCR E�/PORA7IVE COOLERS <br /> URINaL CLpTHESORYERS — y <br /> DRINKIN_,__��p�=Tq�N VENTILA710N FAN y� <br /> FLOOR pRRIN AANGE NOOD —_ � <br /> VACUUM BREAK_HS - AIR HAN�LING UNIT- C F M. � <br /> ROOPOFRIN.-qqINLEADEFS ST��E �„� . <br /> SINK_�ERVICE-BAR,EiC. META(,p�qEPUCE d CHIMNEY N <br /> _ WOODSTOVE/FIqEPLACEINSERT — � <br /> — H('� <br /> I*7 <br /> SIIB TOTp� � <br /> - PENMIT __ f SUB TOTAL � <br /> — TOT�L FEE � PEqM1T f <br /> TOTALFEE � <br /> THIS PORTION TO BE COMPLETED BY BUILOING DEPT. PERSONNEL <br /> rnor�rseio.crc nuascie.cn <br /> Si�ESE18�CK PUNCBGCNNpMBEfl <br /> PL�N�HECK PEE <br /> US[2CNE LOfnqE� FEE <br /> WC�bi 511[ �ECGPt NO <br /> OVLS pN0 FEEB V1ILWTION <br /> TYPEOlCONSI OGGUP�NGYGROUP FEE <br /> NO Of pWELI WG UNIiS <br /> sit[orB�oc noOFstoAmS �WLUiNG <br /> IMx ocC.lo�o S �' � <br /> PLUMBING <br /> F�R[SP(11NKLERS REOUIRED ❑ yES ❑NO MECNaNILAL <br /> �_ <br /> O711ER -- <br /> ��VIICAbpqtCG Iiv Pt�N5C11LClc[o9Y PENALTY <br /> �PVN fOR ISSUAHLf py <br /> T0TJ1� - <br /> � U J�1 <br />