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APPLICATIO� FOR I:ONSTRUCT�N PERMIT �;� <br /> TO BE COMPLETED IN BLACK IHK—PLEASE PRINT !� <br /> HEATING SYSTEM� GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT — <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING _ MECHANICAL ❑PLUMBING ❑ SIGN <br /> pµry MRLL AOD�E55 CILV IIP PN�� <br /> �o.fEn/ P,e��ta%'�_ �, 0• b'ax .rav.� d�/,/v..r �o aa� 4S¢ -66i <br /> iE�NA/N�Ci.',' �/ MRRAOOflE!.S ��_///����,/l P� ' <br /> 9A CIiIIEC 0{IO�UN�iN,��AiILALGN .i / � �,�*�'Sj�/~���y V�1011���� �i <br /> 1 <br /> GfllEP4CON1NNC10q f.G\•^AE55 LIIY ZIP PIqYE ST.VELILENSE/ <br /> ER e�� E ,9y >6 9 J',�I�� kb✓r 9P�� �sf- �si�a�'s6 f'�ir,a�kq. <br /> ,9 <br /> AIE 4NICALLONIBPC'OR M LI.•02255 �� ��TY ZIP P��ONE SiP1EL F SE <br /> f��Q�'Qe�� {�t).,���1���r�� Q��'� �s�i-l.�j-rh's6 �fr/r,Fi,roRT <br /> CI1Y ZIO PNONE SiR1EUCENS^_• <br /> PWMBINGCONIRRGLOF �MAiIA�OBE55 �� <br /> LONTPAGTP(110EOF 11N <br /> (S ll/OD� 1 -nJ / <br /> OESCflIBE Ofll(AY SOU��E��i. �+EINV«VEO� �" v ���TAct^[nSON'U10 NONENO. �Sf �, S/�✓OS//l_ � <br /> Y• C 7-bT —D4T: V p .I <br /> /_ <br /> 1 HEflEBV CERTIFV THAT I HAVE REA� AND E%AMINED THIS . <br /> anovo,eouse orommrt+a APPUCATION AND NNOW iHE SAME TO BE TRIIE AND CORRECT.ALL <br /> � � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> iem�oFuniana�a'vnarenrv�s�ovrt+ouawonnrrncHiwowviesi NOT THELGRANTOING OP A ERMIT'DOES NOT PRIES MEETO GNE <br /> �or e�ocK oF AUTHOflITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY , <br /> (� _ ��.�� / OTHER STATE OR LOCAL LAW flEGULATING WNSTRUCTION OR TNE <br /> �1.(�( (L/(� �� PERFOHMANCE OF CONSTRUCTION.THAT I AM 0' THORIZED BV THE <br /> OWNER OF THIS PFOPERTV TO PERFOFM THE WORK FOR WHICH <br /> O O�PP��CATION IS MA�E AND I COMPLY WITH THE STATE <br /> vnnte�rnxip r+uuo[n O� O/OS `�o / � CONTRACT RSLAW1827RCWAND296200WAG � <br /> ?7� /�O/�� -0300 -ASO ; <br /> =� / � %� <br /> CIX '1R 1qNlOANLEN�E11.�0�flE5S.iELEPl10 'l'�4 O / �/�/ /O�/ � .i <br /> ��2`j SKiN��I��� 2 O O�iL �I <br /> PflOJECTF��RE�v � R � 2h( nre�. � <br /> iasuccN:x <br /> P t1MBING MECHANICAL <br /> NO. TYPEOFFI%TUflEOHITEM FEE NO. TYPEOFEQUIPMENT FEE � <br /> WFTER CLOSET(tOILEn NC-NHNDLG UNITS-H.P. _ <br /> BATHTUB FORCEDAIRSVSTEMS-B.LU. M E.A. ��. <br /> LAVATORV�IVASHBA5IN) UNITHEATEBS-e.T.U. M - <br /> SHD'NEF CLOTHES�RVERS , <br /> HITCHEN SiNK 8�ISP VENTILATION FAN '�� <br /> DISHWASHER fiANGE HOJD � <br /> — "- � WATER HEATER � <br /> LAUNORYTflAY �_ . <br /> CLOTHES WASHER WOOD STOVE <br /> UFINr7. METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FpUNTAIN FIREPLACE INSFRT ' <br /> HEATPUMP � <br /> FLOOR DRAII: _ + <br /> �ACKFLOW PRE\'ENTERS GAS PIPING � <br /> ROOF ORnINS-RAIN!.EADERS E%HAUST FAN � <br /> SINK�SEflVICE-BAR,Ei41 � � <br /> SUBTOTAL 5 � SUBTOT�L 5 <br /> PERMIT 5 PEflM1T 5 <br /> TOTALFEE 5 TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> Fq011i5EiBACN AERPSEi�ACB S:�ESEIBACN PIRNCMECKNU4BEN iEE FECEIPiNO <br /> 5 <br /> UoezaiE Loienen vnc�NrSrtE FEES VAWATION FEE <br /> ❑ VES ❑ NO ppIL�ING <br /> IYGfOfC0115I NOOFSTOPiES IXc��'C� MIdMLvh:bkn5 <br /> PWh101NG <br /> 56EOFplW FlaESPflINKLERSP[00 PISEMENt Id[CHANICAI <br /> ❑ YES ❑ NO <br /> CCCIIPAYGTLOAD FiRERdPMPWO HEIGNiLINIIAiION <br /> AOOITIONAL PIAN CHELK <br /> OTMER <br /> � <br /> PEASON <br /> STATE�UILOING SURCHRRGE <br /> unnxeov vur+seP?tovsoor CITY OF EVEHETT PUBUGWOFNS <br /> !J IM LOCRL SALES � <br /> ORiE <br /> � 1. 1L,y� TA%CO�EIS3105 TOTAL 1 <br /> i <br />