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APPLICATION FG.t Pe <br />C °'"" <br />CRY or CONSTRUCTION <br />r Or <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ® COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />rt <br />OWN,R MAIL ADOREss otv zir rM0' <br />cLIt4,A66W ANv 64j StEU1N� 33d�Lrr,�aol [ Je/G/7" �Jrdd 0"-(v01(P _ <br />NE <br />AODRL SS I",zn, PN - <br />,�ZQA'1 PIKE. <br />J�1 <br />_�-� <br />Llry <br />Ilr <br />PIIOrvE <br />LICENSE <br />4U.1 PFL CONIRALIOR <br />Fun FonuEs <br />CITY <br />ZIP <br />PNONE <br />LICENSE <br />MCUTANIGL CONtRAG OR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUI,iBINB LO'IIRFLIOR <br />MAIL ADDRESS <br />cE A5S or WORK <br />❑ NEW ❑ ADDITION la ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ClBUILDING RELOCATION <br />VAL UAIION Or WORK IC051 Cl IA4CRIALS PLUS E •BORI <br />--grlbo <br />DESCRIBE WORK <br />--4QnA Oei"t...nGNr�ii <br />r,.K,NL_ D,, : >-LTS-rl - <br />UST OF BURDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />TYPE <br />BELOW OR ATTACN FOUR COPIES' <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />HGa DLscRIPuoNonwoPERnlseowN <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN 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 CONSTRUCTION, <br />SIONATURL OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />•PruCAHrS Tr euvNrss ucENSL vn <br />PROJECT ADOPT!sll pot „(uL�� PU` <br />T.iJ,2C ii WASH , <br />MECHANICAL <br />PLUMBING — _.___ <br />NO. <br />TYPE OF EQUIPMENT <br />E <br />- FEE <br />_ <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />WATER CLOSET (TOILER <br />AIRD UNITS-H EA <br />REFRIGERATION UNITS-1/ P E4 <br />REFRIGERATION <br />B47117U0 -_-- <br />OOILERS-H P. EA <br />LAVATORY IWASH BASIN) <br />GAS FIRED AC UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS -BTU M EA. <br />KITCHEN SINKA DISP. <br />WALLHEATERS-BT.U. M. <br />_ <br />DISHWASHER <br />UNIT HEATERS-B T. U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />—_ <br />WATER HEATER <br />VENTILATION FAN <br />_ <br />URINAL <br />RANGE HOOD <br />-- <br />DRINKING FOUNTAIN <br />AIR DUNG UNIT- CFM. <br />FLOORDRAIN <br />__ <br />_— <br />STOVE <br />STOVE <br />---- <br />_ <br />VACUUM BREAKERS <br />METAL HREPLACE A CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />SINKISERVICE-BAR ETC.) <br />WOODSiOVE/FIREPLACE INSERT <br />_ <br />---�. <br />- --- - <br />SUBTOTAL 11 <br />— <br />-- <br />SUBTOTAL <br />-- PERMIT s <br />_ _ PERMIT - IT <br />TOTAL FEE IT <br />_ ___ _ _ TOTAL FEE __ __ 6 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />L <br />