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�N Fr�rprn� <br />an or <br />everett <br />BUILDING DEPARTMENT <br />259•8B10 <br />,,PPLICATION FO�. <br />CONSTRUCTIQN <br />PERMIT <br />TO BE COMPL.ETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION <br />M�II <br />M�h <br />❑ BUILDING <br />� MECHANICAL � PLUMBING <br />arv ! ziv <br />❑ 31GN <br />fikNEReL LONiPALIOA <br />M�II �DOR[55 C.RV IIP �I�ONE IICEN$E • <br />MEd��N�GI [ONtN�LiOfl Id/il �ObRL55 CiIY ZiP P�IONE IiLENSE • <br />PW�BIN.LGNiN�f.tOR M�II �DDNE55 Citt TiP PI�ONF IiCENSE • <br />_. �.. . _'. �_ \ _�' � ni�.�l_ O�. ��."_.I_wl <br />G1�550f WORK � <br />�l] NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAL W TION Of WORF ICO51 Of Ru1CNIelS PL 115 l<NORi <br />PLUMBING <br />N-o.TT'- <br />L <br />USE IONE <br />tVCE Of <br />�.» <br />�WASH <br />KITCMEN SINK b OISP <br />DISMWASHEH <br />UUNORV TR�Y <br />CLOTHES WASHER <br />11RINAL <br />DRINNIN6 FOUNTAIN <br />FLOOR DRA�N <br />ORAINS — I <br />CFRVICE — <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />:µ NE�N SEIB�C• <br />LOIARE� <br />.T OCCUP�NCYGIIC <br />NO Of SiORiE9 <br />IKLERS REOUIRED ❑ YES <br />arr. B� riu�sc��E[nE0 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCESGOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN Oli NOT. THE GRANTING OF A PEflM1T DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. �] <br />SIGNn7UREOFG tRAC10RORAUTMORIZEO�GENi �ATE �^��.�' l <br />J <br />x� ���_ <br />MECMANICAL <br />A/C — A/MNOLG UNITS — M P. <br />nc[oirCPeTInN11NIT5—HP EA. <br />" BOILERS—BTU/HP. <br />QAS fIRED A C. UNITS — B.T.U. <br />FORCED AIR SYStEMS — B T U. <br />W�LL MEFTERS —B T U. <br />uNIT :/EATEP3 — 8 T.U. <br />f <br />f <br />V�CANtSRE <br />❑vF.S �NO <br />ia�o <br />Bv <br />VENTILAT�ON FAN <br />qANGEHOOD <br />WATER MEATER <br />WOODSTOVE <br />METAL FIREPLACE 6 CHIMNEV <br />FIREPLACEINSEflT <br />HEAT PUMP <br />pq5 PIPINO �- ( <br />E%MAUSTFAN <br />BUB TOTAI <br />p[RMIT <br />TOTALfEE <br />PIAN CHECKNUMBER IFEE <br />BUILDING $ <br />PLUMBING <br />MECHANICAL <br />OiHCR <br />STATE DUIIDING SUi1CHARGE <br />STATEcNERGYSURCHARGE <br />PUBIIC WORKS <br />TOTAL <br />M EA. <br />M <br />M <br />RECEIPT NO. <br />PROPERTV L�INE LOCATIONS ANONRELATE� E SEMENTS.�NG ALL <br />