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, .PPLICATION FOk ���,�„ <br /> `".t"'°'"° CONSTRUCTION O <br /> �,n o� <br /> ev�rett PERMIT <br /> BUILDING OEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DCMOLITION ❑ COMBINA710N ❑ BUILDING ,q MECHANICAL ❑ PLUMBING ❑ SIGN <br /> ow�+i.n raui •nm�u;s arv nr r��or�r. <br /> 1 l.: �..J� ..l' ` l/ <br /> w.runri on rn snm��� M�n .nnnis, � orv zu� nnoru <br /> f.Lbiiu� fnHin�C.tOn AQ�� atIDRLSti f,rtr Lr nuON[ i�ctNst. <br /> Mlh1�N�f�1 f(1N1N�f,101� 6UIl M)I1NL5S LIIY 111` PIION[ IICU�51.• �) <br /> �it�•. ' . � ...%��. : ..�. . :/.(��[✓•.�i/l.fy1�/ <br /> : i ' � �%!'.. � � ' i� �!ri <br /> 1YIIMBIN�CONiR1 �JOII MIII �DDo1.55 Ci1V III`i I410NE IICkIRt • <br /> C1�5501 WOAR <br /> ❑ NEW ❑ ADDIiION ❑ ALTERATION ❑ RFPAIR ❑ DEMOLIIION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br /> wi umor+or won.�cosi or u.nn�u.s rius vnniu <br /> C�lniiwl�'♦_ �-Pc'/,a'ic ✓...�P. /�' C: -f.��C✓ <br /> DCSCR�O[�)AK <br /> PciA JC � . l.., H.��„� . . i <br /> us�or eunoivc ' I HEREBV CERTIFY THAT I NAVE READ AND FICAMINED THIS AP- <br /> PLICATION ANO KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> icc+iocscniruowornnontarv�s�ownociov:ou�tucurouncor�is PROVISIONSOFLAWSANDORDINANCE`�GOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> io�_n�oc�_—or 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 REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTFUCTION. . �I <br /> SIGNAlURE01�CONIR�f.10fiD11RlIf110R12En�GlNl D�:F i <br /> X ���. ./n/� �����U ' � 'I <br /> PROIECI eDOPE 55 �PPI ILeNTti GIl Y BUS W f 551 iCl NSC NO . I <br /> '_ � r <br /> PIUMSIN6 ' MECHANICAL � <br /> Np, TYPE OF FIXTURE OR ITEM FEE NO. T'PE OF EOUIPMENT FE! <br /> W�TEF CLOSET��01LET� AIC—A/MNOLG 11NITS—M V. <br /> B�TNTUB REFRIGERAtION UNITS—M P.EA. <br /> LAVATORY IW�SM B�SINI BOILEHS—B.T U�M P <br /> SHQ�R GAS FIREO A C.UNITS—B T.0 ' <br /> NITCHEN SiNK 6 DISP FORCEU AIR SYSTEMS—B T U. M EA. <br /> DISMW/SMER WALLHEATEPS—BTII. M <br /> LAUNDR�TRAY UNIT NEATERi—BS.0 M <br /> CLOTHES W�SMER EVAPOR�TIVE COOlERS -: � <br /> VRINAL CLOTNESDHYER$ � I <br /> DRINKING FOUNTA�N VENTILATION FAN � <br /> FLOOR OR�IN RANGE NOOD <br /> B�CKfIOW PPEVENiERS W�TERIIEATER <br /> ROOF DRAINS—RnINLEA0ER5 w000 STOVE <br /> SINK�SEAVICE—6nH.ETC 1 METAL FIREPLACE 8 CNIMNEV . � <br /> FIREPLACEINSEFT <br /> MEATPUMP <br /> � GA$PIPING � <br /> E%114UST FAN <br /> SUSTOT�L f 9USTOTAL <br /> PERMIT i P[RMIT <br /> TOTAIFEE f TOTALFEE <br /> �nOH�SE1B¢r n[�R SEIB�CK S�OC 5[10�Crc PLAN CNECN NUMBBfl FEE NECEIPT NO. <br /> �,se tone ior enu v�r,�ui snc FEES VALUATION FEE <br /> urls iiuo S � <br /> BUILDING <br /> ni-c nr covsr occuvwr.rcnour r�o r,.ownurmururs <br /> PLUMBING <br /> Si2COfB�DG NO of510R�C5 �.��K �CC �OAD MECHANICAL � <br /> OTHER . <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ Nu STATE BU�LOING SURCfiARGE _ <br /> STATEENERGYSUPCHARGE <br /> u�v��r.abon�r,c t�r r�.nbsC��[tn[o ur ♦�'vn ron issuu¢[ov PUOLIC WORKS --' <br /> TOTAL <br /> PROPERTY OWNERS ARE f7ESPON5IBLE FOR DETERMINING ALL � <br /> PROPERTY LINE LOCA710NS AND RELATED EASEMENTS. � <br />