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� <br /> i~ I <br /> i. <br /> �� '•,'`���lMErc.7r..� . �'PLICATION FOI:� . , ���,�„ <br /> GroF CONSTRUCTION <br /> � everett PERMIT e <br /> � HUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> � ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL LUMBING " �SIGN <br /> �I � MMLADDRESS CITY ZIP PMONE „' � � , <br /> OWNER <br /> � /'�,t�/�(�s�[-f %�'��3 �11��L'� .i�. ��': <br /> � ARZHIT CTOR�ESIONER Me�LA00RE55 GIT' ZIV PNONE <br /> i <br /> ' GENEN�I GOhIF�CtOR M�I���ORE55 CiiY 21P VHONE LICENSE• <br /> � <br /> �� MECHANIW�CONTfl�GiOq M�IL�DORE55 GITY ZIP PHONE IICENSE• <br /> ry <br /> ; . . <br /> �� �� GIUMBIN(3GONTRACtOR MML�OORE55 CiIY 21P PNONE L�LENSE• <br /> '� ��.r/A>i� ��li �2�/�[.ioY P/� �S`�%�'f/.3/ 7�L��S�013?-</� <br /> � � LA9 OF YIORK <br /> j �NEW ❑ APDITION ❑ ALTERATION ❑ REPA�R ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> � V�IWTIONOFWOAN�WSTOf MAiERUlSPWSLRBORI <br /> l <br /> �I ,�`1�D'.ESCRIBE WORR ' <br /> ; - ` <br /> j EOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> �j ��STR�2 ` PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> � LEAALDESCRIPTIONOFVpOPERTYISHOWNBELOWORRITACHFOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE� <br /> ; i.or—e�ocK—or INORNOT.THEGSANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � ANY OiHER STAT'e OR LOCAL LAW REGULATING CONSTRUCTION <br /> ��p OR THE PERFORMANCE OF CUNSTRUCTION. . <br /> '1 , SIGNFTUFE OF CONTRACTOR OR AUTHOR12ED AGENT OATE <br /> f <br /> ��]]1 y � � �� <br /> � ^ <br /> .' ��(9ROJEGTADDRESS A IC�NTSCIi USiNESSUCEN ENO <br /> �V ` //� � "J <br /> PLUM8ING MECHANICAL � <br /> NO. TYPE OF FI7ITURE OR ITEM FEE NO. TYPE QF EOUIPMENT FEE <br /> ' WATER CLOSET�TOILET) A/C—A/MNDLO UNITS—H.P. <br /> ' 9ATMTUB REFRIGEPATIONUNITS—H.P.EA. <br />� � �l UVATORY�WASMOASIN) BOILERS—B.T.U./H.P. ' � i <br /> 9�J SHOWER OASFIREDA.C.UNITS—B.T.U. <br /> ;y KITCHEN SINK d O�SP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> � WAILHEA7ERS—B.T.U. M <br /> 'J . DISMWASNER <br /> � I <br /> UUNDHVTRAV UNITHEATERS—B.T.U. M <br /> � CLOTHES WASHEH EVAPORATIVECOOLEflS _ <br /> ��� � URINAL CLOTHESORYERS <br /> VENTILATION FAN ' <br /> 5 DRINNING FOUNTAIN �i <br /> � FIOORORAW � FANGEHOOD ' <br /> � - � � �BACKFLOW PREVENTERS WATER HEATER __ �. <br /> � � ROOFDHA�NS—AAINLEAOEPS WOOOSTOVE <br /> S�NK ISERVICE—BAR,E7C.1 METAL FIREPLACE 8 CHIMNEV <br /> � FIREPIACE INSEHT <br /> HEAT PUMP <br /> ii - - - GAS PIPINQ � <br /> � ' EXHAUSTFAN <br /> :1 <br /> � SUB TOTAL f SUBTOTAL � <br /> �� PERMIT i P[PMIT <br /> : <br /> TOTAL FEE f TOTAL FEE <br /> � � frIONTSET9�CR pE�RSETBnCN SIDESETBACK PLANCHECKNUMBER FEE NECEIPTNO. <br /> r <br /> � USE20NE LOTAnEF VACANTSITE FEES VALUATION FEE <br /> . .. OYES ONO � <br /> 7YPEOFCONST. OCCUPANCYGNOUP NO,OFDWELLINOUNITS BUILDING S <br /> '� • PLUMBING <br /> 312EOFBLW. �NO.OFSTOPIES Mex.7CC,LOAO MECMANICAL <br /> � <br /> i <br /> j OTHER <br /> 0 FIRE SPRINKLEPS REOUIRED ❑YES ❑ NO STATE BUILDING SURCHARGE <br /> 3 � STATEENERGYSUFCHARGE <br /> 9 �PPLIC�110NACC BV PL�NSL'NECNED6Y APPR FORISSU�NLEBV PUBUCWORKS <br /> , <br /> 1 � .. <br /> TOTAL <br /> 1 • <br /> PRQPFRN OWNERS AiiE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br /> � <br /> ... ..ri::s .,a , ,.-,c.�. ......y� � .S••-1.i7'..nw�.+.�.��•,._ _ <br />