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. . fh1 Ewrpreen <br />LITY OF <br />� evere�t <br />BUILDING DEPARTMENT <br />259•8745 <br />E�r"lPPLICATION FO�Yj <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING <br />_.....__ una nooness <br />u� <br />❑ MECHANICAL G,j�LUMBING <br />� nn PNONE <br />everetl <br />e <br />❑ SIGN <br />�� GENEfi�LGONiR�GTO(1 MRILROOR[55 ��TY Zi� PHONE LICENSE• <br />MR G4nJSi /C/73�f h�E. $rr•r /2EOM0,•/O �F�^27�/ <br />MECHRNICALCONif1�ClOq MALL�DORE55 ��TY Z�P PMONE ���NSE�S <br />t <br />L't7.zF�.rJ .znlG �ni�+4 m.o � sr 11E[�VuF , %�OOf� l/fH-�'J2i Zuc OQ <br />M�IIA�ORE55 C�N 2iP PIIONE UCENSE <br />PLOM�VIG GONTflAGtOF Cfb^�F C� <br />, G,U,�S/SOFWORN <br />� L'� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSf:RT ❑ 9UILDING fiELOCATION <br />. Vr1lWTI0NOF1V4BN�COSTOFMAIEBIAL5PW5LABORI <br />' �F3'ODO <br />� oescnioewor+K <br />- useoveuaowc <br />LEpAL OCSGHiP110N OF <br />� �or_ �� ocK— <br />, PROJECiA�DfiE55 <br />� 78/� E <br />PLUMB!NG <br />I NO. <br />j WhTER CLC <br />BATHTUB <br />;.AVATORV I <br />SNOWER <br />KIT �HEN 51 <br />. �.��..wncu <br />9 <br />I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUE ANDC9RRECT. ALL <br />OELOWOiIATTACMFUURGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. TI1E GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIQNAIURE OF CONi(IACTOR OR AUTHOR2ED �GENT �ATE <br />x <br />� <br />wAY 13�0� � <br />CH71 <br />P. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />fVEARSEt6ACN SIOESET9RCK PLANCNEGKNIIMDER PLANCNF.LNFEE <br />FFC �PEGEIMHO. <br />i USE20NE <br />, TVPEOFCONST. <br />' SIZEOFOLDQ. <br />1 <br />FIRE SPRINKLER; <br />qPPIILAiIOKnCC OY <br />SiORIES <br />CMEGNEDOY <br />V�C�NT SITE <br />OVES ONO <br />N0. OF pWEL <br />LOAp <br />FOf1 <br />BUILDINO <br />PLUMBING <br />MECHANICAL <br />OTHEH <br />PENAITY <br />TOTAL <br />FEES I VALUATION I FEE <br />S <br />