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tMEr�iyrwn APPLICATION fOR � <br /> �'^°� everttt <br /> everett CONpERMITT�ON e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINA�'ION F�BUILOING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNf,R M�II�pORE56 ('i��. )iv <br /> /�p 'J� �`rONt <br /> r/� �1.�� �� J/a/�/'1L��-L� //�.s'/ �C'l'�� I � � / f.l. -/' � <br /> .���-H�,tri in�i r i oo Ess <! /S 1���'j ( � !� <br /> • vH��Ht <br /> ,�vcuac�omta�r.ion ra�n �nonEss orv �r. <br /> n��nNF �iGN�9C• <br /> ���v`_T_r? ✓��r[� 35�1,. S», rf1,.,�,� E:��s��l r.��� �y��/ "'i� �g <br /> ♦r<.uwcai CnNfP�CUN M �OORE94 C��� <br /> C��v bP PMONE ` IICRIS[ • <br /> VwMPiN�.f�R��v��.��ID — 1� ^)��I I1�I/ 1 �CJ �•L� <br /> � M�q.AD�Nf55 ll PIIONf <br /> IV1fNti1 • <br /> CI�SSOI WfiBr �- � <br /> � NEW ❑ AD�ITION ❑ ALTERATION ❑ RSP�IR ❑ OEMOLITION ❑ WOODSTOVE;FRPLINSERT <br /> ❑ BUILDING RELOCAlION <br /> VIL 111���)M1 Ll!Wl lq. .1()51�11 M1�t�1�1.�I.Ll1S L�HnRi <br /> ,�/,Si,�� <:_ -- <br /> M1t]f tLtik WUNx Y <br /> ..I�L��/� /d /\�0�� � �.. !��' , i J��//� ... <br /> v�.i irB�_i�D�N. � �! �=ri-1_—IZ'� � l�CI � �:� � � <br /> ( ,��r�� /� 1 HER[8'/ CERTI�V THAT I HAVE READ AND ERAMINED THIS Ap� <br /> � � � "` � PLICATIONANDHNOWTHESAME70BETRUEANDCORqECTAL� <br /> �.i�••� ncs�����o+�oronoornn�srownneiowon.ruc�.rouneoores PROVISIONSOFLAWSAN�ORDINANCESGOVERNINGTHISTVP[ <br /> / <br /> „����Bi��K_��. i i. A �' OFWQqHWILLB"cCOMPLETEDWITHWNETHERSPECIFIEDHERE� <br /> IN OR N0T THEGRANTINGOFA PERMITDOESNOT PRESUME TO <br /> � GNE AU7HOAiTY TO VIGIATE OR CANCEL THE PROVISIONS OF <br /> ANVOTHER STATE OR LOCA�LAW qEGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSiRUCTION. <br /> SicNqtt7uE�i Co�npq�.rGnpnqun�on�tFD+cEr�r t�ntt <br /> �� 7 ��C� � �/. ��7C1 ' �� ��: ' . � - -'L,�_ �� �ri��5 / <br /> vNpAEC��ODNE55 �Pv� 'INrtipt�q��ti�NfSSuqNtiFNO i <br /> PLUMBINQ MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> W�TEPC�OSE7ITOILE:1 MC -�,HNOl6UN115-HP �— <br /> BATHTVB REFRIGE�qiION UNITS-M P EA <br /> U V�TORY 1 WASM BASINI 901LER5-8 7 U�H P <br /> SMpWER GASFIREDAC UNITS-BTU <br /> kI7CMEN SIN1c 6 DISP FOACEO niR SvSTEMS-B T U M EA <br /> CISHW�SNER WALL HEATERS-B T U M <br /> LAUNpRV iqAY <br /> UNITMEATERS-BTU M <br /> CLOTNE$W�SMER EVnPOPA�IVE COOLERS <br /> URINAL <br /> CIOTHES OA�E(i5 <br /> _ DRINItING FOUI/7AIN VENTIIATION FAN <br /> F{,OOR ORAIN R�NGE MO00 <br /> BACNFLOW PREVENTERS WA7ER HEATER � <br /> FOOF DRAINS-RAINLEA�ERS WOOD STOVE <br /> SiNK i5E9VICE-BRR.E?C I METnL FlFEPLACE e CMIMNEV <br /> FIREPUCE INSERT <br /> MEFTPUMP <br /> _ OAS P�PING <br /> EIfHAUSi FAN <br /> !Ue TOTAL f 6U0 TOT�L <br /> PERMIi � <br /> P[RMIT <br /> TOTAL F[! f TOT�L F[E <br /> '""4'sf nf+� . af+n s[�e�cr 5�oe 4[rB�Cx nAN�C'jn4/Ck/N�UMBE�R/ FEE1 �) RELEIPT NO]/� <br /> ��4f1/Nf ItIr�RF• � II 1 (�l' � S�IL)`7�' Il� / ( C_� <br /> v.c•nisrte FEES VALUATION FEE <br /> 5P� i5-83 y�,7.� ,.Es�,a --- <br /> �.y a� �.ovv oc"uveperuRoun r�n nrnwF�uHuu�+ns BUILDING � ` . ��.� <br /> -K M- � � R.UMBING <br /> S:f O� P�fl. NO Uf S�OHiES M�[ O:C 10�0 <br /> 'ZOS� I N� MECMANICAI <br /> OTHER <br /> �iRF.SPqINKLERS REOUIFED ❑ VES NO <br /> STATE OWLDING SUNCHARGE <br /> ST�TEENERGYSURCHARGF. <br /> ���'�"�����'•' � A� �l�NSCHECkEDBY �pPRfORi55U�NCkO• <br /> ��,,yyr PUBLIC WORKS <br /> �-jJ�1 ��- �` ' G • ?OTAL <br /> PRfPbRT'� OWNERS ARE RESPONSIBLE POR GETERMINMCi ALL <br /> PPCPEurV11NE LOCAilON5AN0 RELATFDFASEMENTS <br />