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.�.�PLlC/��'IOIV F��. <br /> ,na E'°,`,°°° C O IV S T R U ��'i� I� everetl <br /> cin ov � <br /> everett �� �t� �r <br /> BUILDING DEPARTMENT <br /> 259-8810 TO OE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING 17 MECHANICAL ❑ PLUMBING ❑ SIGN <br />' O14NER MAllAODRC.iS ❑Iv :�.F PMONE <br /> N/e��.�r� f s'.�,"//� /�o,B,�X .�1``�2 .,Si� >`/�c���� /`'8:.>d' G5"3-aU2 s� <br /> �� CHIiECiUHUP.iIGNFH fAFiLADDPE55 CIiY [�V PNONE <br /> GEN[fiAL LCNTPAGiOR MAII a��RE55 Cltt 1�P PHO�JL �ICEqSE• I '�J <br /> S�r�n� lrle�um �k'O /' � <br /> r.ILCHnviC.rt.coNUlaCiOq bwRADOREss clrr ZiP nHONE L�cErbr. � <br /> PLU'ABIN3CONIRAC.ipq M4i1_PO��C55 CrtV 21P PnOrvE LICLN51' • <br /> CLASSO-WORN <br /> NE:W ❑ �DDI7IUN ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ 1VOUDSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V4 WAiIUN Of\40RF.�COSi pi A�AtEqIAlS�LUS LABOR� <br /> �7 � �D C� __i <br /> ❑CSGRIBL WOPH � <br /> Iusr oF Ecaoir�c / ��J �-( ��� I HEREBY CERTIFY THAT I HAVE READ AND EY.4MINED THIS AP� <br /> -G�ur�� r��"'u'Y �� U°�� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> ��rr,�oe. �P*�or+oraHoaearris�� vr�oeibwoanrrna�ruuacovies� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYP[ <br /> 7 ,c OFWORKWILLBECOMPLETEDWITHWIiETHERSPECIFIEDHERE� <br /> �o,��s�ocK—o�� ��' S�� v IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHEF STATE OR LOCAL LAW REGULATING CONS-RUCTION <br /> OR THE PERF09MANCE OF CONSTRUCTION. <br /> s�cr+AlunEpr�coqt;-nc�cRORauTMORiI.E�.GtNr ��nrE <br /> X l �� / � ,3� �� <br /> �� <br /> PFOJEGIADDRE$$ APVLICANifiCI:Y[?Uti:��Cti5liC61btNfi � <br /> ���� - /0 �� , S,�` <br /> PLUMBING MECHANICA! <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE Of EOUIPMENT FEE <br /> WATER CLOSET�TOILET� AiC—AMNOLG UM:7�—::(' �'� <br /> BATMTl1B j REFqIGERATIONUNITS—MPEA �� <br /> LAVATORY�WASHBASIN� J BOILEflS—B.TU,HP � <br /> SHOWER GAS FIRED n C.UNITS—8.T U <br /> I KITCHEN SINK d DISP f0(7CED AIR SVSTEMS—9 T U M EA. . <br /> DISHWASHER WALLHEATERS—B.TU. M <br /> LAUN�RV TFAY UNIT HEATERS—B.T U M <br /> CLOTHESLVASHER EVAPORATNECOOLERS <br /> URINAL CLOTHESOFVERS � I <br /> DRINNING FOUNTAIN V[NTILATION FAN I <br /> FLOOR ORAIN RANGE HOOD � <br /> BACKFIOW PqEVENTERS WATEF HEATER <br /> ROOF DRAINS—RAINLEAOEFS WOOD STOVE <br /> SINK�SERVICE—BAR.ETC) METAL FIREPLACE S CtiIMNEV <br /> FIREPUICE INSERi <br /> NEAT PUMP <br /> GAS PIPING <br /> E%NAUSTFAN <br /> SU!�TOTAL S SUB TOTAL ' S <br /> PEFMIT f PERMIT <br /> TOTFLfEE 5 TOTAIFEF � �) <br /> I ���urns[*Unr.v. ivennSEtf��.CK Sm[s[reaer: � ����N��+ CKNUMBER FEE FECEIPTNO <br /> /eK AI' �2'1 � 'l 7 � ��/� J� , �l <br /> � 9 0 0 �F- S � . �J �� ._� � �J�-��'�1 , <br /> �ca.tiut �oraata ���,r,nr�.srtc FEES VALUATION FEE <br /> " 7 7 � �rs ::rvo � G otJ " <br /> �+�-eoFr.or�s occuvancvcnour� r�oorowi-�unaurms �UI��iNG 5�-�_ �� C �l� <br /> I ' h� � - �� PLUMBWG �/ C. . <br /> i <br /> �,r[ or n�o� No oF sror�ies max occ �.ono <br /> MECHANICAL Z �, <br /> / �L��i <br /> OTHEH <br /> FIRE SPRINKLERS REOUIREO ❑ YES i3�NO STATE BUILDING SURCHARGE ,7 S U <br /> STATEENERGYSUFCHARGE �� . <br /> �. r,i;qpON/.c: E3� PLANSCHECKED BY Ai'f u f'JR IiSU/NGE OY �7 <br /> PUBLIC�YOFKS <br /> � _ O� 7 � <br /> ; / � � �/ ( I . TOTAL S 3 � c � <br /> __'—_ !—� v�'J tii <br /> PROPLRTY O1'JIJEHS�RE P65POt1g19L'e FOR DFTGRLIINING ALL <br /> PROPEFTY LINE LOCATIONSI�NU FEI.�1fCD FFSELI[D:iS <br />