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��,-.PPLICATION fOQ ��� <br /> p`�»�'°'�' CONSTRUCTION O . <br /> everett P�RINIT <br /> BUILDING DEPARTMENT TO BE COMNLEI'ED I!J I��K - PIEASE PRINT <br /> 259•8810 . / <br /> � DEMOLITION ❑COMBINATION @'BUILDING ❑ MECHAN:CAL ❑ PLUMBINt; ❑81GN <br /> euR MIDHI.SS CIIY T�^ PNDNI: <br /> OWNER <br /> " :cv� r'"'u���, s� ?s'/3 /�3 :%i/ S t .�,,..•<��r y%r���� 3S 7 3ii� <br /> 1RCMIiECf OR pIS�OHEA <br /> M+�i+nm[.s c ��� reorii <br /> OFNER��GONIR�C�OR M��l��I��C55 C�tr I��' �PpM[ L�GENSE• <br /> �'ct<Q. '�rv S �� � � � � i i owPnsR,r iG,t� <br /> MECM�A.J��.OM1��OOq <br /> M�IL�ODAL45 C I O E LICENSE <br /> PIUME�N6 CONIA�CIOn <br /> MMI �Ofl�(SS C��Y Zil` PUDNE IICEHSE• <br /> CUSS Of wOAK <br /> �NEW ❑ ADUITION CI ALTERAIION ❑ REPAIR ❑ Ohb101.lIlON ❑ WOO�SIOVE/FRVL.INSERT ❑ BUILDING RELOCATION <br /> v�W�lioMo�WOA^M1'o5�nr U�InutSrluSl�nOni.� <br /> � /�5,� <br /> oexn�sE wonK _ <br /> /� / ��,ri ..vn c, <br /> U�E O�bU on.a I NEReBV CERTIFY TNAT I HAVE READ AND EXAMINED THIS AP� <br /> � ��`;�, j71 PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEQ�LDESCNiPIIOHO��AOpEA1Y�5110WNBElO�VOA�»����fOU�C0�1[51 PROVISIONSOFLAWSANDORDINANCESGOVERNIN6THISTVPE <br /> G Q �� i �j, /��S Of WORK WIIL BEi.OMPLETED WITH WHETHERSPECIFIEDMERE• <br /> io��s�o��,�L_oi IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUiHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> t'" " ���, � �M e� ` � � ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> Tcr ¢'. : p ° OR THE PERFORMANCE OF CONSTRUCTION. . <br /> f- ���1� t-' • <br /> SIGN�1UnE U� I:ONinnCtOR UB nU1��Oni2E0�GENT D�TE <br /> t �: l• <br /> X ,.P n � „� -8 7 <br /> Ce�NyY L�'��' •oour•r�rsu�rnus�erssucn�sn�o <br /> MqJEGf�DDAf SS <br /> �� � �� �!�! / . <br /> �LUMOIN� MECHANICAL <br /> FE! <br /> MO. TY►!Of flXTU11[OII ITEM FEE NO. TYPE OF EOUIPMENT i <br /> WIITEP CLOSET ITOIIET� AiC—��MNOlO UNITS—M P. '� <br /> REFRIGERATION UNITS—H P.EA. I <br /> 7ATM7UB � <br /> LAVATORYIWASM A�SIN� <br /> "' BOILEPS—O TL/M�. <br /> GAS FIRED�D.UNITS—B.T.U. <br /> � SHOWER <br /> FORCEO�iN SYSTEMS—8 T.U. M F�� <br /> NITCHEN SINR 8 DiSP CO M <br /> I OISMWASNER ' W�LLNEATERS—BTLL � <br /> LAUNDRY TR�Y UNIT NEATERS—BS U. M <br /> � E��POR�TIVECOOlERS <br /> CIOTMES W�SMER CLOTNES DRYERS <br /> URINAL <br /> VENTIUTION F�N <br /> DMNKIN6FOUNT�IN q�NGENOOD <br /> FLOOA DAAIN <br /> W�TER NEATER <br /> BACNFLOW PNEVENiENS WOODStOVE <br /> ROOF DR�INS—Q��NLE�DERS METRI FINEPLACE 6 CHIMNEY <br /> SINK�SERVIGE—BI1R.ETC� FIREPUCE INSEPT <br /> HEATPUMP <br /> G�S PIPIN6 <br /> EkH�USTFAN <br /> EU!TOTAL <br /> fUe TOTIIL f <br /> P[RMIT <br /> ►ERMIT � <br /> TOT�LfEE <br /> TOT�L FEE f <br /> i+�qN�ME .K NUMBER FEE ^� RECEIPT NO. <br /> raUwtSF�o�C�� nc�nSE�B�c� S��es[ronCK/ ��yc ...� �/G'�S q03�� <br /> a 5 __9;S ccS� f �7 i_�� c�.� <br /> us[zoeE ior�ne� �ec��r sne FEES VAlUAT10N �E <br /> 5 /�1 �'7$ OYfS I]NO � <br /> J BUILDING S <br /> tYPEOiCONSi OCCU�ANL�'Gf10UP NOU�OW�LLINGUNIIS <br /> ' �N R��3 7lUMBING <br /> S�iE Of BlD6 HO O���f5 M�K OCC IO�D MECHANICAL <br /> o� 6 C=AR 85o Z NK <br /> OTIIER <br /> FIRE SPRINKlERS REOUIRED ❑ YES NO STATE BUILD�NG SURCHARGE <br /> STATEENERG�SURCHnPGE <br /> �PPLiLA��ONeGCd� PUNSLNECKEO�Y API'RfO��55WNGCOY PUB�ICWORKS <br /> � � TOTAL <br /> PROPERiY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> p^OPERTV LINE LOCA710NS AND RELAYEO EASEMENTS. <br />