Laserfiche WebLink
IN Erup Nn <br />CI('/ OF <br />ev��rett <br />BUILDING DEPARTMENT <br />259•8745 <br />'�--.APPLICATI�M F(.R <br />C�NSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK• PLEASE PRINT <br />everen <br />e <br />❑ DEMOLlTION ❑ COMBINATION f3 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER ^ /� MAILAODRE55 Cltt ZIP PHqNE <br />S'.� w id'.a Y�AS' S G r'sld' ,: iJs�feeo•v/Lf i`"l��Ao l7�a✓�p <br />� <br />M�IL �OONE55 <br />sv <br />cm ziv <br />�I..S./'�d Mif/%L <br />GI1Y 'IP <br />7�,���a ���• sa -. <br />cm zir <br />CI1Y 21P <br />,3-s y-16rr <br />PNONE UCENSE• <br />�A�- 6�s/ r.s�r.�,• <br />PIIONE LILENSE • <br />CL�SS OF WORK <br />❑ NEW ❑ �ODITION � ALTERATION ❑ REPAIR ❑ DEAIOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V�IUATION� WONN�COS70F MRtERI�LS PLUSLP90R� <br />yS00 *� _ <br />oesc� �woAK I �. � . I - � � � - -- � .. . .. _ T� . .. <br />:SH <br />fRONTSEiB�CN <br />�t .a <br />�-N <br />SIZE OF Ol�a <br />IQo S� <br />Ev�ti1J <rJ�v. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINFD THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONSOF IAWSAND ORDINANCESGOVERNIIJG THISTVPE <br />OF WORK WILL 8E COMPLETED WITH Wi1ETHEp SPE.CIFIED HEFE <br />IN OR NOT. THE GFANTING OF A PERMIT OOES NOT.� PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCF.L THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATl1REOFWNTRACTORORAUTHOFI2EDAGENT OATE �4/t/�� <br />X �� � � _. <br />TYPE OF EOUI <br />UNI75—H.P. EA. <br />\iION UNITS—H.i <br />H.P. EA. <br />AC. UNITS—TON <br />R SVSTEMS—B.T. <br />fEFS—B.T.U. N <br />ERS—B.T.U. M <br />IVE COOLERS <br />7RYERS <br />)N FAN <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />N•A• <br />RFER <br />� A <br />P� �Z <br />� OF SIORIES <br />� � fdiE <br />SI�E <br />VACAN7 SITE <br />oxes pWo <br />no. or owe� <br />0 <br />� <br />110NACC�BY PLANSCHECNEUBY IAPPN.FORISSU�NCE <br />s� J�- �. �, <br />! 73 <br />fEE3 <br />BUILOINO <br />vi.un+eiva <br />MELMAYICAL <br />OTHER <br />PENALTY <br />TO'AL <br />PLRN <br />FEE /J� �� I <br />VRLWiION <br />REC! ��/� <br />FEE , <br />