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����Il�ll�'O � �O� � everetl <br /> ' '".E".,°'"" COfdSTRUCT'iON @ <br /> ; cm cF <br /> � everett P� RM �T <br /> BUILDING DEPARTMENT <br /> + 259•8850 TO 8E COMPLETED IN INK - PLEASE PRINT <br /> { <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> MA�LAODRE55 CItY ZIP PIIONE i <br /> �—�/l/�C _ �iiC�/ti� /�n09 /¢�`Q2< Sc �'v�T 9B2A8 337 - 793/ � <br /> �'� ARCHIiEGTORDlSiWER MFILN��PE55 G�iY ZI�' PHONE <br /> GENERALGOHiRAGTOR <br /> MAIL ApORE55 Gn' LIP �HONL ��CENSE• <br /> . — 4�it7lt�+/� - - <br /> MECMANICAL CONTRF�IOq MAIL nODRE55 <br /> � VlUM81NOCOMRFG�OR . MPILRD��E55 Ci�V LIP f'110NE LIC6NSE� '� <br /> LI GL�690F WOHN I <br /> 9 � NEyy ❑ ADDITION ❑ ALTERATu�N ❑ REPAIR ❑ DEMOLITION ❑ WOC�DSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION I <br /> �� i <br /> VALUATION OF WONH ICOSi OG M1�iERIALS PLUS l/•90Ni � <br /> � - � �- �, �szp' <br /> �qpE CRIBE WOFK <br /> � � ¢l� rJ� v/L� TA?-��� Su�U�UDot9 2 tJG�Gq <br /> � �USEOFBUILDiNG I HERE�Y CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> � /rL-p/k�•A�r//Jii� /NQ �}� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> � LEGAL�ESLRIPTIONOFPRO ALY�SMOWN9ELON R/.1TAGHFOUAGOPIE51 PROVISIONSOPLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> �'r � � C ��,e� /n�_—��5�� OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT BLOG�—OF �'�+ IN OR NOT.THE GflANTING OFA PERMIT DOES NOT PRESUME TO <br /> `; GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �'� . ANY OT ATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> '�t OR TH ER ORM C- F CONSTRUCTION. <br /> �± SIGNATI .� OP ON1RA V A;TMORI2ED AGENT [IATy <br /> �.'{ �f��Cl O <br /> ,�� PROJECiA00RE5$ AnPLILPNI' ILILTOUSINESSUGENS NO <br /> ;--- G ZDoZ —!4�'` O/G, S'.E, �tiC��T �,cJ�4, <br /> '' PLUMBING MECHANICAL <br /> ,i <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYP�OF EQUIPMENT FEE <br /> �� WATEP CLOSET�TOILET) A/C—AiHN�LG UNITS—H P. <br /> -1 6ATHTUO REFFIGERATION UNIT$—H P EA. <br /> ;r .� ' LAVATORV(WASM BASIN) BOIIERS—BS.LL/HP � �� <br /> � SHOWER GASFIREDAGUNITS—B.T.U. <br /> �.�� NITCHEN SINK 6 OISP. • '.'ORCEU�iR SVSTEMS—BS.U. M EA. — <br /> OISHWASHER 'NALLMEATERS—B.T.U. M <br /> y LAUNORY TRAV UNIT HE�TERS—BS U. M <br /> �.^;� CIOTHES WASMER EVAPORATIVE COOLERS <br /> URINAL CLOTHESORYEPS <br /> ,� <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> ��y . FLOOF ORAIN RANGE HOOD <br /> �� BACKFLOW PfiEVENTEAS WATER HEATER <br /> ROOF DPAINS—F7A�NLEAOERS WOOD STOVE <br /> �ry METAL FIREPLACE d CHIMNEY <br /> $INK ISERVICE—BAR.ETC� <br /> f FIREPLACEINSERI' <br /> � HEAT PUMP <br /> :j GAS PIPING _ <br /> � E%HAUSTFAN , <br /> f�� <br /> 9 S119 TOTAL i <br /> SUBTOTAL S <br /> ��' PERMIT ' <br /> ti pERM�T f <br /> �`.� TOTAL FEE S YOTAL FEE <br /> �:'�' - PIAN GME N NUM�ER FEE FECEIPT NO. � <br /> ;� FRONT SEiBACN iiEAR SEtBRCK SiOF SEiOACN �y J �� � ,-�- �� '/,rt�,�^��� <br /> ,'� c J D �����7 �J � LJ V <br /> use zorve �or nnen vncnNr siri FEES VALUATION FEE <br /> I,� ❑vE5 f]NO 5 � <br /> BU�LOING <br /> '� 1VPEO�ST. �GCUPANCVG�OU� NOOFOWELIINGUN1iS <br /> ,7 V�N �(/� -�� �}- PLUMBING <br /> �J� <br /> S12E OF�LDG �� NO OF SfOR1E5 IAax OCC.IORD MECHANICAL <br /> I`; / N4 <br /> :� OTHER � 7S 35�' <br /> � � FIRE SPRINKLERS REOUIR[D ❑ YES 1:0 STATE BUILDING SU(7CHARGE <br /> I <br /> STATEENEFGYSUPCHARGE <br /> �i <br /> y APP�ILAIION ACL 0! �'L!NS LNECK[D_BY APPR FOR ISSUPNCE OV pUBLIC W�RK$ <br /> ��'��.(/ // 2 G <br /> ��� �A/� �o�— / ��TA�. 'J ✓ <br /> �ii ✓i <br /> � PROPERTY OWNERS ARE RESPONSIBLE FOR DElERMINING ALL <br /> ��. PROPGRTY LINE LOCATIONS AND FiELATED EASEMENTS � <br /> ' .... .. " ..,,,� .,..,_ _... . .. - . _ . _ . . .. , _.. , <br /> :a�?..._�.ar _ �.,�,'�r ��4. .3d�i � . . . . l' . . ,. . . . , . . ii . � . . . , . . . . ,. , . . I <br />