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i-:�'PLICATION FQi. <br />'"'E""°'"" CONSTRUCTION <br />cm or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING �J SIGN <br />owr�rn u+ii�nnn�ss cnv �u� vunr�e <br />��� <br />�LJ�n,f ! tJ �y-i �O. �ng a �U •`-' E t1-i i z [ ` ll � I <br />u�o�ut.r.tonutsua�rn u�nnuonts, cnr tn, runvi <br />Eeoi-,�,t y�7'SM393aI <br />rtrn.�u�cUHinrc�on u�n nUmass arv ---�m rin;rrt ucu�st. <br />n�EvE� si�n.� lin`f i �-+c��a `�`t �� r,?r. utT��o,� 9�.z>� ���°�- �3.�s <br />ivann M���nnnn[ss � nn in runr�[ u[rnsr. <br />PLUMOINliCON�B�G�O� !AAII Appll[$i f.1�Y lIP f'110N[ UCENSL • <br />❑ NEw ❑ �DD iION ❑ ALTERATION ❑ nernin ❑ D&MO1J110N ❑ WOOf75iqVE/fRPLJN,enT O euiu Nc nr.i.ocnnor� <br />v�L W � Nrl Ur Wtpu if.o51 J� r V �I ����15 P1115 V.!pIL <br />� 3sOC'•°�' - <br />DFSC�iO[ wONe <br />1�V 57 /i�-G_ NEu/ Foo �'I )v4S �4 rv i) �U crES �,7 N' Eltil /LC U 1Y1, i�i� ic E-�i G N� <br />��cr nr nrm mur. <br />P%3�� <br />PLUMBIPIG <br />NO. TTPE OF FlEiI <br />WATER CLOSET �TOILET� <br />BATHTUB <br />LAVATOf1Y �WASH BASIN� <br />SHOWER <br />NITCMEN $INK d DISP <br />WA: 'ER <br />DRINNING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENT <br />ROOF ORAINS — RAI� <br />SINK ISERVICE — BA� <br />�uUNrSF�D�L� <br />nc� <br />v�, � <br />C•Iil <br />SUBTOTAI f <br />PEPMIT f <br />TOTALfEE ! <br />N[�R SE19�CN <br />lpf MIC• <br />occur•ricr cn <br />110 OI SfOR1E5 <br />]I V l .]C 1 tlnl.n <br />I IIEREBY CEFTIFY THAf I HAVE f1EAD AND EXAMiNED Tf115 AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WIiH WHETHER SPECIFIED HERE� <br />IN OR NOT. TI1E GRANTING OF A PEPMI7 DOES NOT PRESUME TO <br />G�VE AUTHOFITY TO VIOLATE OR CANC'cL THE PROVISIOPlS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSiRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN41UpE Of LONiIiAf.tOq O(1 RLLLI.IOfiiZE� RGfNi DAiE <br />X - � �2-X �- <br />♦rrur.u� �cnvnusir�[ssucu�s[No <br />MECHANICAL <br />FEE NO. TYPE OF EOU��ME <br />A/C — A/HNDLC UNITS — N P <br />REFRIGERATION UNITS — H P EA. <br />OOILERS — B T U/f� P <br />GAS FIIIED AA. UNI f5 — B.T.U. <br />FOFCED AIR SY'iTEM �— � T U. <br />WALL HEATERS — B T.'J. <br />UNIT MEATERS — O.7.U. <br />EVAPORATIVE COOLERS <br />CLOTHESDRYEHS <br />VENTILATION FAN <br />PANGEHOOD <br />WATERHEATER �� <br />wOODSTOVE <br />� METAL FIREPLACE S CHIMNEV <br />MEAT PIIMP <br />GAS PIPING <br />E%HAl15T FAN <br />P�aN CHEC6 NUMDE{I <br />v�cerrt srtc FEES <br />�res ���o <br />r�o ar ow� uu+c ururs <br />:OaD <br />rier�scr�eCK[Dor ervnronissu�r�Ccor <br />� � <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />�FEE <br />�UILDING <br />PLUM�ING <br />iAECMPNICAL <br />OTRER <br />STATE BUILD�NG SU�CHAnG <br />STATEENERGYSURCHAPGE <br />PUBLIC WOBKS <br />TOTAL <br />5 <br />M EA. <br />M <br />M <br />�-/9-��S <br />RECEIPT NO. <br />PROPF.RTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALl <br />PROAERIV LINE LOCATIONS AND FELATED EAS[MENIS. <br />