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�PPLIC,ATION f0`� <br />�^•E~'°'�^ CONSTRUCTION <br />cm or <br />everett E'ERMIT <br />BUILDING DEPARTMENT TO BE CONi°LETED IN INK- PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �LUMBING ❑ SIGN <br />OWNER <br />M�ILAqDPE55 ��n' ��P PHONE <br />,. . .,,�.�„-..i y_cnv /°' [., .rF�J �s'ri9 ,Jd'"y f,' 27 <br />OENE/RT�ICONTR�CIOP MnIU0�AE55 ��T�' ZiP vNONE LICENSE• <br />MELM�NIGLCONTP�CiOq MAILAO�RE55 Cltt ZIP P110NE LICENSE� I <br />FWMBINOCONTR�LiOR MAILADOAE55 CITY 21P PNONE LICENSE• <br />� <br />GlA9H OF WORK <br />❑ NEW ADDITION ❑ A�TERATION ❑ AEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V�W�TION Of WOAN IWST O� MAIERIAIS PWS L�BORI <br />p e� <br />1' <br />CFBCRIlEWOPK . � �/ /� � f � <br />lEO�L OESCNIPTION O� PROVEHtt �SHOWN 9ElOW OR Ai1AGM lUUM wncm <br />LOI�� BlOG1t� O� <br />1 ly�d )// �'+ •1l 1 OQc�.,��: �La� <br />Y <br />�G� I 1l: / � / - <br />S�G� G��,..�OP F',�,�c,l/ C,i:. <br />PPOJECTAODRESS / <br />Bi/(1 l )/ � !i J ( �ii�7 / l/['� <br />PLUMSIN6 <br />NO. TYPE OF FIXTURE OR ITEM FE <br />'� WIITER CLOSET 1TOILE7� <br />B�TNTUB <br />UVATORV�WASMB�SIN) �� <br />/ SMOWEN <br />NITCHEN SINK 6 DISP. <br />OISMW�SNER <br />' UUNDRV TRI1V <br />GLOME9 W�9MER <br />URINAI <br />DRINI(INO FOUNTAIN �� <br />� FLOOADNAIN � <br />BACKFLOW PREVENTERS <br />ROOF DNAINS — NAINLEAOERS <br />SINK �SERVICE — BAR. ETC.� <br />fUs TOT11L = <br />PERMIT � � <br />TOT�L FEE f <br />iRONTSEiB�Cn AE�RSEiB�CN SIpE5E1B�CN <br />USEZONE LOiARE� V�CANTSrtE <br />�YES ONO <br />TYPEOFCONSi. OCCUPANCYGROUP NO.OfOWELIIN <br />�... ne e� nn un nF eTnnIFS M�X. OGC IO�D <br />Bv <br />�PPR. f01i i55U�NCE BV <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIED HERE• <br />IN Of; NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITV TO b:OLATE OR CANCEL THE PROVISIONS OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGN�IUPE Of CONfF�CTOR OR RUiNOR12ED AGENT O�TE <br />X rh'Is',���-1«� i <br />•VFUC�N�S GI1Y AUS�NESS LILENSE NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C — A/HNOLC UNITS — M P. <br />REFRIGER�TION UNITS — H.P. EA. <br />B01LER5—B.TU./MP. ' � <br />GAS FIRED 11�C. UNITS — B T.U. <br />FORCED �iR SVSTEMS — B T.U. M EA. <br />WALLMEATERS—B.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPONATIVECOOLERS <br />CLOTMESDRYERS <br />VENTIIATION FAN <br />RANGEHOOD <br />W�TER MEATER <br />WOODSTOVE <br />METAL FIREGUCE 6 CMIMNEV <br />FIREPLACE�NSERT <br />MEAT PUMP <br />OI15 PIPINO <br />E%HRUSTFA� <br />lUBTOTAL <br />� TOTALFE! 9 _ <br />PI,AN I;MECN NUMBER I FEE I RECEIPT NO. <br />BUIL�ING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARG <br />STATEENERGVSURCHARGE <br />Pl1BLIC WORKS <br />TOTAL <br />$ <br />PROPERTY LOINE LOCATIONS ANDNRELATED EASEMENTISING ALL <br />w <br />. '• . .:.-�r,;..;. , <br />