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�;APPLICATION F(:,-R <br /> '�'E"'°"'� CON�TRUCTION °"°'°" <br /> CITY OF <br /> �verett PERMIT e <br /> BUILDING DEPARTMENT <br /> 25s•8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION QrBU1LDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWIi(P M�ILADOPE59 CItY ZIP PNONE <br /> P�D fd1U�S7 MLNT CoiZP- ,Ui�v_r- /�� /�� �l�i,,,�rv p,F dl�,,,� <br /> •RCNITECTORDES�ONER MM��ODPE53 CIIY 21P Al10NE <br /> C/�%uC- D�Sic-p �SSUC.. �ZoG�'284-(, S6 <br /> GENER�LGONiR�CiOR M�IL��ORELS .-�S 2� �2� + h �J���Iy.�, Z�p PNONE LICENSE• <br /> L/,�A�c- r�,v Cc�n,�srilu�r�a�v �-�E2�rr-^_yr, �i�_ 9��- �z�>,�s��s�y� I�r�9E,�� <br /> MEL'N�NIC�ICONTR1LIOq MMI�DDRESS � CITY ZIP P110NE LICENSE� <br /> PIAMBIN�CONIPACIOR MAIIAD�RE55 Cltt 21P PIIONE LILENSE• <br /> CUSS OF WORN . <br /> ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR C� DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�IU�TION Oi WOPN��pgiOF M�iERULS PL119 LAEOR� <br /> /I <br /> Y /C. Gu o <br /> DESCRI WORR <br /> 1 ; P �_ z F e� — o-�'-F' � - snhcL- <br /> U9E Of BUIlDINO . <br /> � � � � I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED TNIS AP• <br /> ' ` ' PLICATIONANDKNOWTHESAMETOBETRUFANDCORRE�T.ALL <br /> 1E6111DE5CPIPiIONOFPROPERi � NBELOWOR�TT�CHFOURCOPIES7 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHiR SPECIFIED HERE• <br /> LOT_BLOGK_OF IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> GIVE AU:HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTF;lCTION. <br /> SIONAiUREOFCONTRACiORORRUTMORIZEDAGEN? DATE <br /> i � <br /> X � li�zr ��- <br /> 'ROJECT�OORE55 �PPLIC�Ni5C1T INESSLICENSENO. <br /> lzr �.�_ �r�r. ;r�,�1 L G� v _ <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TUHE FEE ND. TYPE OF EOUIPMENT FEE <br /> WATEfl CLOSET�TOILEn AIR COND. UNITS—H.P.EA. <br /> BATHTUB qEFRiGERATION UNITS—H.P.EA <br /> LAVATORY�WASH BASIN� BOILERS—H.P.EA. <br /> SHOWER OAS FIREO AC.UNITS—TONNAGE E0. <br /> NITCHEN SINKB DISP. FORCEO AIR SYSTcMS—B.T.U. M EA. <br /> DISHWASHER WALL HEA7ERS—B.T.U. M <br /> LAUNDRYTRAY UNITHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORnTiYE COOLERS . � <br /> WATER HEATER CLOTHES ORYEfiS <br /> URINAL � VENTILATION FAN <br /> _ DRINNING FOUNTAIN RANGE HO00 � <br /> FLpOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREANEFS STOVE <br /> ROOF ORAINS—RqItJIEADERS METAL FIREPLACE 8 CHIMNEV <br /> SINH�SERVICE—BAR,F.TC. N'OODSTOVE/FIREPLACEtNSERT <br /> SU9TOTAL SUBTOTAL S � <br /> PERMIT S PEBMIT S I <br /> _ TOTALFEE S TOTALFEE S <br /> THIS PORTION TJ BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> •ONISEtORGN RE�i!S_EI/PsC:w: SIOESEiB�LK PLANCHECK UMpEf1 PUNCbEGNFEE <br /> 'V �M �� � �Si\ � FEE //� �SO REGEIPTNO. <br /> EZONE IOiAREn �J �J <br /> C�, p� n VAC�NTSITE FEES V�LU�TION FEE <br /> I V�FH OVBS pN0 <br /> `���HST� OGCUPAryyYGBOUP NO.OFOWElLIN0UN173 � <br /> _[��N i��Z � <br /> euaoiNo s <br /> 'e ov oioo rvo or sromes n+nx occ.to�o <br /> PIUMBINO <br /> MECN�NICAI I <br /> �7E SPRINKLERS REOUIR[D ❑ VES NO <br /> OTHER <br /> PENALTY <br /> �'LIUIION RCC Ox PLANS CIIECNEO OY 1PPR.FOIi ISSp�NCE PY ' <br /> J� TOTAL <br />