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?PLICATION FOk <br />CITY of PYPreD <br />CITE"'°'"° CONSTRUCTION <br />everett PF R W T <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY 7W PHONE <br />MA44 L- MOSCS 4-2-ZI So. :5 F-„crz T lj'z.-ycZ <br />ARCHITECT OR DESIGNER MAIL AODHE55 CITY ZIP PHONE <br />ENE�So�� AsScclacES R2ol BIiOE10 ✓ T S Tlri 'E I DvE.t4;Tr jo2nl 2S•1- Sa'S7 <br />GENERAL CONTRACTOR /1'L�A MAIL ADDRESS ' CRY ZIP PHONE LICENSE <br />CLASS OF WORK rY <br />❑ NEW ❑ ADDITION p ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />11 <br />Y/ L' . <br />OESCRIBE WORK <br />' <br />) <br />iALi GiA fl01`� YO Ek.l&?II�. li AYSEI <br />'N <br />+ <br />USE OF BUILDING <br />I HER'_14Y CERTIFY THA HAVE READ AND EXAMINED THIS AP- <br />FsIDL TY • L <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DE?CRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />9 <br />'� <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />gE+ 3 pLAf OF LvwGL�, p ✓. <br />LOTI—B_—OF <br />LOCK <br />IN OR NOT. THE GRANTING OF PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH E R STATE OR LOCAL LAW R EG ULATI NG CONSTR UCTI ON <br />IIrL. y A4. 313 <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AU IHORIZED AGENT DATE <br />X nO <br />PROJECT ADDRESS <br />'-T� <br />APPL'CARrS CtfYBUSINESS LICE#ITENO <br />/,rvL <br />¢'d"Ll 5-- 1*" i. 0E•e�T 'JB20? <br />PLUMBING <br />MECHANICAL <br />�1 0. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.R EA. <br />BATHTUB <br />O <br />REFRIGERATION UNITS—H. P. EA. <br />LAVATORY (WASH BASIN) <br />_ <br />BOILERS—H. P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK f DISR <br />_gJO <br />I ORCED AIR SYSTEMS—B.T.U. M EA, <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ _� <br />_ _� <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />_ _ <br />_ <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE f CHIMNEY <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVEIFIREPL CE INSEiT <br />SUB TOTAL <br />_ <br />SUBTOTAL S <br />PERMIT S <br />PERMIT f <br />_ <br />TOTALFEE f <br />TOTALFEE f <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK SIDE SEitlAOK �•^^ <br />CI_/ LOTAREA VACANT SITE <br />FEES <br />OYES )KNO <br />y YY <br />"—J <br />2— <br />BUILDING <br />' BLDG <br />N0. OF STORIES <br />MAX. OCO LOAD <br />PLUMBING <br />SPRINKLERS REQUIRED ❑ YES 4NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />ATION ACC BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />L.G. <br />TOTAL <br />— <br />FEE�O�UN CHECK F <br />RECEIPT <br />VALUATION <br />CoUL-� <br />FEE <br />