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� �'PPLICATION FO�i�� ���.� <br /> � p E�'�^ CONSTRUCTION <br /> ' everett PERMIT e <br /> �; BUILDING DEPARTMENT Tli BE COMPLETED IN INK- PLEASE PRINT <br /> � 269•8810 <br /> '� ❑ DEMOLITION O COMBINATIVN �BUILDING O MECHANICAL O PLUMBING ❑SIGN <br /> � M�ILADORE55 ��TY ZIP PHONE ' <br /> � OWNER � II A �`/� ) ^w2 h �f <br /> T! � L 4���� //�trYY�G�� ` �lC�C6'«r7/' :P/ �Jl`'J PNONE ��JS � �/ � <br /> f ARCMRECTOROESIONER MML��ORESS <br /> 4 <br /> i AAIL�DORE55 CItY Z�� P��ONE LICENBE• <br /> 'n OENER�LGONTR�LiON ' <br /> 1` � <br /> MECH�NIWlGO TA��TOq M�IL�DDNESS C�iY 21P PNONE LICEN6E• <br /> � M�IL�DDRE55 CITY 21P PIIONE UCENSE• — <br /> � PLUMlINOCONTP�CTON <br /> �\ CL/�BSOFWOP1c �y '. ��T-- <br /> 9 yO��NEWptWOONKCOSTOIFOM�TERI❑�LSVLU9RBOpON ❑ HEPAIR ❑ DEMOLITION y� WOODSTOV IFRPL.INSERT>❑ BUILDING RELOC�.TION <br /> � I :SG'� ao <br /> DE6CRIOE P1c � . <br /> l �c 4 . � <br /> us�orew�oino I HEREBY CERTIFY THAT I HAVE READ �1ND EXAMINED THIS AP• <br /> � �L�� � S PLICA710NANDKNOWTHESAMETOBETRUEANDCORRECT.ALI <br /> IEO/J.DE9CM�PTIONOF VERTY�SMOWHBELOWOR�T7�GMi0UFCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �or__e�oc�—oi 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 REGULATI NG CONS7RUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . � <br /> SIGNATUREOFCONTR�CTORORAUTHOR¢EOAGENT DATE <br /> � � � [ /F� <br /> � - ', � � r �L'w� `/ <br /> MOJEGT�DDRE69 AP IL�NiSGITYBU5IHE59UCEN5E <br /> ,� M HANICAL <br /> � rLUMlING �E <br /> � Np, TYPE OF FlXTUNE OR ITEM FEE NO. 7YPE OF EOUIVMENT <br /> WATER CLOSET ITOILET� IVC—NHNDL6 UNITS—H.P. <br /> REFFIGER�iIOH UNITS—M.P.EA. <br /> e�n+Tue <br /> UVATORY IWASM BASIN) BOILERS—B.T.0/H.P. <br /> QAS FIRED A.C.UNIT$—B.T.U. <br /> SNOWER <br /> � 1(ITCMEN SINK 6 DISP. FORCED AIR SVSTEMS—O.T.U. M��� <br /> WALLHEATERS—B.T.U. M <br /> DIBMNASHER <br /> UNIT HEATERS—O.T.U. M <br /> ' UUNDRV TR�V <br /> CLOTMEB W�SHER EVPPOR�TIVE COOLERS <br /> CLOTHESDRYERS <br /> URINAL <br /> � VENTIUTION FAN <br /> DRINI(INO FOU'1TAIN <br /> �� RANOEHOOD <br /> FIpOH DRI11N � <br /> � BI1CKFlOWPREVENTER:i WATERHEATER <br /> ROOF OPAINS—N111NLEAJER3 WOOD STOVE <br /> $INK ISERVICE—BAR,ETC.) MEf11L FIREPUCE 6 LMIMNEY <br /> FIPEPUCE INSERT � <br /> HEAT PUMP <br /> pAS PIPINO <br /> E%HAUSTFAN <br /> fUSTOTAL f EUOTOTAL <br /> PERMIT f V[RMIT <br /> TOTALfEE f T0TIILFEE <br /> FAONT7EIB�GR RE�R SEIB�CR SIDESEiB�CN <br /> PLAN CMECK NUMBER FEE RECE�PT�' <br /> USE 20NE LOT�REA y�C�NT SITE FEES VALUATION �E <br /> + , orEs oNo BUILDING S <br /> TYPEOFGONST. OCCUV�NCYGROUP NOAFOWELIINGUNITS <br /> � , PLUMB�NG <br /> ' SizE or B�oa No.OF STOaiE9 M�x.oGa�o�D MECHANICAI. <br /> � OTNER <br /> F!RE SPRINKLERS AEOUIRED O YES ❑ NO STATE BUILDING SURCHARGE <br /> { � STATEENERGYSUHCHARGE <br /> � <br /> � �VP4C�110N�CC BV PL�NSCMEG1cE08Y �PPA.FORISSU�NCEBY pUBLIGWORKS �� <br /> � TOTAI <br /> PROPERTYL�INE OCATONSANDNRELA'EfEDEA9EMENT'g�NOALL <br /> '�:i: ;r��c .�"c�i:` ' .,... �,'i:�!*r•' •'.C;��i <br /> .�;.:.•y . �.. .;t. .�i.��'.��:^':T-_i..r, � . <br />