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TMF�ro� i-.PPLICATION FOhJ everen <br /> everett CON ERM TTION O <br /> BUILD�NG DEPARTMENT <br /> 259-8;45 TO BE COMPLETED IN INK- PLEASE PRIIYT <br /> O DEMOLITtON �COMBINATION �UILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWq(11 M�ILAUDRESS GIIV 21P PMONE <br /> � ScN��.�A�3 3als s,rL�e ,r„ F vt ve� �I E�LO 3 3s S 6�5 Z <br /> 1nGutCG10RDlSIUNER M�IL�OONE95 Cltt ZiP PHONC <br /> RL�t1tC�� � JdI�NS�sI 19(,p/ z'Src� N 1 Ses��/Q SS'b 2z�� <br /> 4LNlRALGON�R�L�OR M�IL�OORE55 GIIY Z�P CNONE �ICLNGf• <br /> MI.C�UN�ULCOH�P�LiOfl M�IL�OORE55 . CIIV ZIP PIIUNC UCCHSt <br /> FIUMq�N.CON1ReQOR M�ILADORE55 gltt Z�p ppOq� ����Hy� � <br /> u�s5 ur wonn <br /> ❑ NEW �ADDITIO� ❑ AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING PELOCnTION <br /> VM W tIUN Of WOfIM1��051 O� Mn�I luel g PlUS UBORI - <br /> (a9� tiy7, 5 6 <br /> ot scmut woi+n <br /> aJ� 1;� ;� , ., v er rou� ' ve �ua�e / k,���e <br /> usi.or ewioiNa <br /> v.e S��J(' K� E I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS AP� <br /> PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> uO�l OLSC1111910NOfPROPEHtY�S110WNIlEIOWOR�i1�CNi0URGOPIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINGTNISiVPE <br /> OF WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �a�_moc�ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHE TATE OF LOCAL LAW REGULATING CONSTRUCTION <br /> S` e �� f e� OR THE P FORMANCE OF CO STRUCTION. <br /> C /( SIGN�TIIR FCONTRRC NORAtITHO 2 AGENt On1E <br /> . A / � I <br /> v � Q � 3 c�Li <br /> i'�+011f,t Appn65 �VP�ICANiS CIIY BUSINESS IICENSC NO <br /> '��zj SI+e�Ue i( ✓ � �vPre'EE- Q'82c,3 <br /> PLUMBING MECMANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEiiCLOSEt�TOILEp S UO AIRCOND.UNITS-H.P.EA _L_ <br /> I BAiNTUB LL� REFPIGERATION UNIiS-H.P.EA. <br /> LAVATORV�WASHBASIN� � OOILERS-HP.EA. <br /> SHOWER (1� Gn5 FIRED AC.UNITS-TONNAGC E� <br /> � KITCHEN SINN 8 OISR PORCED AIR SYSTEMS-B 7.U. M EA <br /> _ I DISNWASMER �j EO WALLNEATERS-B.T.U. M <br /> LAUNOHY TRAY UNIT MEAiERS-BT.U. M <br /> CLOTHES WASNER EVAPORATIVECOOLERS <br /> _ WATERNEATER CLOiHESORVERS <br /> URINM � VENTILATION FAN <br /> - 1�_ <br /> ORINKING FOUNTAIN RANGE NO00 (dC�_ <br /> _ FLOOR DRAIN AIR NANOLING UNIT- C.FM. <br /> VRCUUM BREAKERS $TOVE <br /> ROOF�qAIN$-RAINLEADERS METAL FIREPLACE 8 CHIMNEY <br /> SINR�SERVICE-BAR,ETC. WOOOSTOVE/FIREPLACE INSERT <br /> ,_ SUB TOTAL �JO SUB TOT�I f � � OV <br /> __ PERMIT f PERMIT f <br /> __ _ TOTAL FEE t TOTAL FEE S I Qy_ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> InUNI5F10�LK nlnn5CI0A�N SIDESEiB�CN FL�NCII[GNNUMBER 1`UNCULCn1EE <br /> � / �/ p IQ U/ �U / ree .7c1� }`3 nicuri Ho pr,;J�� <br /> OV� <br /> U'vt tONL LOi MGv y�CANi 5 iE <br /> J���_v OYES�NO FEES V�lU11TtON fE[ _ _ <br /> IYPCOIfON51 OCCUPnNCYGROUP NO.QFpWILINGIlNItS <br /> �� /1� ��. 1 _ � � BUILDING S�pq �L�'�� �cI-'—�I \ <br /> tiVCu� IfIUG IIUOfS1URIlE5 MA[OCC.l0�0 �l. Sv <br /> `I_C.�) I nl/�J/ �(.� PlUM01NG 3p ♦�/� <br /> w <br /> MEGHANICRL L � �`- <br /> flti[SPt71NKlERS REOUIPED ❑VES O NO -�Y <br /> OTHEIi I J O <br /> PENALiY <br /> AI`i•I�CAIu1N�Lf. l1Y PUNSGIICC1tkOBY �PPN.FOPISSUANC[BY - - - <br /> TOTAL � ��(� <br /> � � � <br /> 1� �� J, . <br />