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r <br /> l <br /> � .�PPi.ICATI(�N F�e� � <br /> ,� fNEwrpreen �ONSTRUC�IiJN everen <br /> ' cm oF <br /> ev�rett PE �tA�11T' � <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COPdPLETED IN INK- PLEASE PRINT <br /> � DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> . O1Y�G� ��E���AAIL��fiESS CITY 21P PIIONi: � <br /> ;�1� N9ur, ��rt o /�c.vQ Fu[rPrR °�f'za3 355-57/ <br /> ARCMrtECTORDE5IGNER' _ MniLADflI[55 CRv )iP P��ON[ <br /> � or ja,�r a ,�N3���,�� c�;/�'�1� �X � 11 l� 35�'//0 / <br /> GFNEMLCONIfiACTOR M/ILAOUft[55 GIIY ZiP P��ONL �ICF.fIS� � <br /> MECMANIC4L GQNIPAGiOq lAAll ADOR[SS CIIY III` PIIUN[ LIC[N$[� <br /> PWM1�BINGCONIpAJiO�i Id41lA0�R[5$ GIY ❑V PIIONE I,ICENSE+ <br /> GLASSOF WORN <br /> � NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR. ❑ DEh10LITION ❑ WOODSTOVE/FRPL.INSEH__ ❑ BUILDING flELOCATlO�I <br /> VRWATION OF WORN�COSi O�M1IATE/ilALS PWS LA�ON <br /> �✓) O�' <br /> ' OESCRIBE WORN� � �— <br /> �v'�^✓d�,,.,..e; - - :'��,�PC�LE /�d M.c,y �E� , <br /> � use oF aw�ou�c I HEREBY CERTIFY THAT I HAVE READ AND EXAh11NED THIS AP- <br /> � � � � r ����''����' ���� �PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEGBl�ESCflIPt10NOFPPOPEBiY15HOWN�ELOWO'�iTnCMFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> . 'I ?� ����� JT��_�j- c� OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE� <br /> LOT.�C_L_BLOCH-OF �+V IN OR NOT.TIiE GRANTING OFA PERMIT DO[S NOT PRESUME TO <br /> , GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTh1ER ST�TE OR LOCAL LAW REGULATING CONSTRUCTIOfJ <br /> — OR TNE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURL OF CONIRACTOR OH AU7HOf�IZE�AGENT pATE <br /> � `�/1/t r;�� GJ�,�-�t� S � -�� <br /> PROJECi AODFE55 APPIICANiS Cliv pIISINESSIICEflS[�l0 <br /> g���r p S.l�. �U. <br /> PLUMBING MCCHANICAL <br /> ' NO. TYPE OF FI%TURE �FEE-]—�, NO. TYPE OF E�UIPMENT FEE <br /> WATEFi CLOSET�TOILEn tryw l.IR OND. UNITS–H.P. EA. <br /> BFTHTUB �r1�[� REFRIGERATION UNITS–H.P. EA. <br /> � � LAVATURY�WASH BASIN� �yT DOILERS–hI.P.EA. <br /> , / s7C SHOWEfl aU GAS FIRE�AC. UNITS–TONNAGE EA <br /> � NITCHEN SINK&DISP. CX� FORCED AIR SYSTEMS–B.T.U. h1 EA. ' <br /> . �ISHWASHER WALL NEATERS–�.T.U. M <br /> , LAUNDRVTRAY UNITHLATE(7S–B.T.U. M <br /> � I CLOTHES WASHER EVAPOFiATN[COOLERS <br /> WA1ER HEAiER OV � CLOTHES DflYERS _ � � <br /> � URINAL � VENTILAT'ION FAN �2 UO � <br /> � DP.INKING FOUNTAIN qANGE FI000 __ _ � �� . <br /> � fLOOR DRAIN AIR HANDLING UNIT– QF.M. � <br /> ; VACUUM BREAKERS STOVE <br /> � NOOF Of7AIN5–RAINLEAOERS h7ETAL FIREPLACE fl CHIA7NLV <br /> - SINK�SERVICE–BAP.ETC.) WOODSTOVE/FIREPLACH INSE(iT <br /> � SUB TOTAL SUB TOTAL 5 �1 (JU <br /> PERMIT 5 �-� PEFlMIT S 7 <br /> � TOTAL FEE S '(ilD TOTAL FEE S 1 � <br /> T•iIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> IRONI�SEIp/A�CN RF.4RSE1BnCK SIpESE[�dCN PLnHCH[Ck UMtI[❑ PLnNC��ECK�C.E �] <br /> V" � Y �� II� I J/ �[[ (%(7�� /S I1ECEiPi NU 7!V/N <br /> US[20NE IOtARE4 � _ <br /> � VACANi SiIE FEES VAWATION FEE <br /> LYPEO�NSiI OCC�A��fl�� NOOFUWELLItlGUNli$ �11� � p�C.�` IC' <br /> J.sl_ <br /> `��i�.f ��� � (!1- ) ouaoi�� z 70j�•� 3 3 G� <br /> sizc ov a�oc. no or sronies �nnx occ iono — ---- <br /> «�.g �1�3 S''t.gM•I I — PLUM1701t1G 2� a� <br /> IdEG11ANICAL 2� O/l <br /> l/ <br /> FIR[SPRINKLERS RE(]UIRED Ll Y[S NO -- - <br /> oi��EN <br /> � PENA�T1' , /^i. p/�� <br /> . AVPLICAbONACC UY ' PLANSCHEGNEDOY APPN �O�ISSU�NC[UY _ ���_��� � <br /> . ��� TOTAL �� <br /> L �° <br /> ; � -I'�� �. � ..-. -------- - <br />