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I'' ll � I ( j( I � � <br /> APPLIC�,,fl0ld FOR CONSTRI.�.TION <br /> PERMIT <br /> ine e.e,vreo„ <br /> ciTv or ''°`'"°° <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•88t0 TO BE COMPLETED Ilv INK— PLFASE PRINT <br /> OWNCR I.UII �DOPf.ti'v � Gilv f � !II' P40NL <br /> ` - tiiCt � `� � (' Idt •� . �� �!i�. � iii �� r�< < , t ( t1 -1�•�C'� —�-�°�Cl. � ,� <br /> � C lCC -- ------ — -- -- - —_�t• — -- .�_ �� <br /> 1[N�Nf ��II.�OPqLSS GtY lIP VIION[ <br /> •qpNITECtORDES�GN[II ti���I�D�R[SS CIiY - ZIP PIION[ <br /> GENEP4CONTR�CLOR M�II�P[1R[SS GtY tIP PIIONE LiCENSE• <br /> M GN�NIC4CONTR� iOR M1111Df]RCSS -- ����❑IY—'�-'"— - - -�$IP RION[ � LIf.ENSE• <br /> L��.[ n 'li'(i11�1 ifi'. `,�1�'Lri�'��''I } l��(� �-._��lLl'.�L� �Lz_;��''.i'—�I �.��1�1,1 .{ � r.. <br /> UMBMQLONIR TON MAILAOD 455 � QfY IIP PHONC LILENS � <br /> cussotMvnK ---__-.—. --._ -_. ____--- - <br /> ❑ NEW ❑ ADDITION /ITER�TION ❑ fiEPA1R ❑ DEMOLITION ❑ WOO�STOVUFHPL.INS[Ri_ ❑ 13UILOIN6RELOCATION <br /> TCH�NIIMPROVEMENIORIM[RIOP [� ❑.ONtY GONIACiPEfi50N�NOP110HlNO <br /> CpNTR�CT MILE OF WOpK <br /> p( �8E Rn N SOU� [fOOt�G[iNVO1VCD <br /> �l.�j�, ) , - (� � P �r1' ;•-�-�( � ��.-(-�-�— _- ---_�--- —�—� <br /> wqro9Eo�1�[OF���oi � IH[REBYCERTIFVTNPTIHAVEREADANDE%AMINEDiNIS�PPUC�TIONAND <br /> - �1 ��' _ MNOWTMESAMETOBETRUEANDCORRECTALLPROVISION90fUN/SAND <br /> LEO�lDESGPNI�ONOf"PO�ERttI5HCM9H BEIOW ORAIT�CM fOUPLOMES URDINANCES GOVERNING THIS TVPE OF WORK WIIL BE COMPLETED WR11 <br /> WNEIHERSP[GFIEDMEREINOFNOT.THEGRANTIN60FAPERMI?OOE9N0T <br /> PRESUME TO GWE AUTHORIiV TO VIOLNTE OR CRNCEL TNE PROVISIONS OF <br /> lOT BioLK ev - - ANYO111ERSTATEORLOCALLAWREGUTATINCCONSTRUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.iHAT I AM AUTMORIZED BY THE OWNEP OP <br /> iNIS PROPLRTV TO P[RFORM THE WOPK FOR WHICH APPLICATION I5�IADE <br /> AND I COMPLV WITl1 71/E STAiE CONTRACiORS LAW 18.27 RCN' AND <br /> 296200 W.4C. � <br /> s�GNelunc0l'corvilleClORnHM1iHORVEOIGENi o4E <br /> 1/ t �' , <br /> PROJECTMORF.55 � A <br /> �' () + PPL1C/�YiSGIDlYBU51N�5S�E�NO�N��/I��tW�IECI� <br /> / ����' 1 \� l/ ��_(�.•(- � <br /> PWMSINO MECHANICAI <br /> 11p, TYPE OF FII(TURE OR ITEM FEE Nq. TYPE OF EOUIPMENT FEE <br /> WIRERCLOSETITOILETI ___ WC-WMIIDLPUNITS-HP <br /> BATMTUB �I FOFCED AIR SVSTEMS--e.L . -nd EA <br /> LAVATORV(WpSH BASINI UNIT HEATERS--B.T.U. M <br /> SHOWER CLOTHE;:DqVERS <br /> NITCHEN SINN 8 DISP. VENTILPTION FAN ______ <br /> _ — ___ _ - _ <br /> DISMW�SMER _ _ RANGE HOOD <br /> _ _ __ _--_' _' ___'- ____._'_ "_. __"_ __ -_ .__.._. ._ _ '.__- _ <br /> LAUNDRVTRAV ____ _ ____ I -. WATERNEAIEN <br /> . _ ______ . _ - __.___.___.__-- ___.- <br /> CIOTHES WASNER WOOD L70VE _ _ <br /> URINAL _ METAL F;REPLACE 8 CHIMNEV _ <br /> DRINKING FOUNTAIN _FIREPLACE INSGRi_ _ _ _ <br /> FLOOR ORIIN - - � — -- " �I[AT PUIdP __ <br /> BACNFLOW PREVENTERS ? GAS PIPING <br /> ROOFDRAINS-RAINLEADERS __ __ _ �- _E%HAUSiFAN _ <br /> SINN�SERVIGE-BAR,ETCI ___ _ __ _. _ _--.--_ - <br /> SUBTOTAI S ---- — -__ - - _ ___ _ SUBTOTAL _ 3 _ <br /> PERMIT S _______ PERMII_ b _ _ <br /> iOiAL FEE b TOTAL FEE S <br /> fRONT'aETB�GN RURSE'B�CY. Si0E5R0ALN PUHCNECKNUMBEP FEE PECEIPfNO. <br /> use2or�e iotenu wewrtsite FEES VALUATION FEE <br /> II Y[S ll NO <br /> BUILDING _ <br /> tYPEOFCANST. OCCUPANGY6ROUP NOOFOWEILINGUNIIS _ - <br /> •L�ow�BlEiec*U�� p�_UMBING <br /> - .. ___.'-__.__ _--- <br /> SrzEoretoa rvoOFSTonieS BSMr ocCio>o MECHANICAL <br /> uv <br /> un _.__-_-____ ._._.-- ___- _— <br /> H[IGNTLIMITAIION OTHER <br /> (IRESPHINKIER�REOUIRE� ❑YES ❑No �STATE BUILOING SURGHARGE <br /> STATE ENERGV SURCHAfiGE <br /> APMIC�TION�GLOY vieHSRrrner PUBLICWORKS <br /> TOTAL <br />