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rn. ev.ro••�n <br />c:n oc <br />ev�rett <br />BUILDING DEPARTMENT <br />259•8810 <br />c;.� ; >;, <br />;�;��PLICATION FOi�=� <br />CONSTRUCTION <br />PE�RMIT <br />TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ D�MOLITION ❑ COMBINATION <br />❑ BUILUI►JG ❑ MECHANICAL <br />•_� <br />G <br />❑ SIGN <br />GENEMLLONTRAGLOH MeiLR00FE55 G�tY Z�P PIiONE LICENSE• <br />MECH�NIC�L WMfl�L10q MAIL ROOHE55 CRV ZIP PHONE LILENSE • <br />FI.UM6INGGONTP�GTOR M�ILROOHE55 �_� CIIY � 21V PIIONE LICENSE• <br />❑ NEW ❑ ADOITION�� ALTERA710N ❑ PEPAIfi ❑ DEMOLIiION ❑ WOODSTOVE/FRPI.INS'cRT ❑ BUILDING RELOCATION <br />V�LUATION OF WORN �COSi OF MRiEPi�LS PLIIS LPBON <br />(SHOWN <br />PLUMBING <br />NO. TYPE OF i°Il <br />W�TER CLOSET (TOIIi <br />BATMTUB <br />LAVATOFlV (WASH BA<. <br />SMOWER <br />NITCMEN SINK d DISP. <br />UUN�RV TRAV <br />CLOTNES WRSHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOH DRAIN ' <br />BACKFLOW PPEVENTERS <br />ROOF DRAINS — RAtNLEAOERS <br />SINK �SERVICE — BAR. ETC.) <br />FRONTSEIBACN <br />USE <br />ave�oc <br />SUBTOTAL <br />PEIIMIT <br />TOTALFEE <br />HE�fl SETB<CM <br />IOTAREA <br />OCGUPRNGYGFOUP <br />NO.OF STORIES <br />RED ❑ YES D I <br />PLANS CHECKED 8Y <br />�'� <br />FEE <br />SIDE SETBACN <br />V�CRNT SIIE <br />OYES ONO <br />N0. OF UWELLING UNITS <br />L�hDA <br />ron issuee�ce er <br />�� �+C� �.ELA^j �� � ,�`3Ld�j8S <br />I HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINEU THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LF,WSAND ORDINANCESGOVERNI�IG THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPFCIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL TH = PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW flEGULATING CCN �I i:UCTION <br />OR THE PER ORMANCE OF ONSTRUCTION. . <br />SIGNATURE O IRACTGR OR T ORI2F AGENT D�fE <br />X �,� .���.,� �,;�_�� <br />MECHANICAL <br />A/C — A/HNDLG UNITS — H.P. <br />HCFRIGERATION UNITS — H.P. EA. <br />001LEflS — B.T.U./H.P. <br />GAS FIRED A.C. UNIT,�, — B.T.U. <br />FORCED AIR SVSTEMS — B.T.U. <br />WALL NEATER.i — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />VENTIIATION FAN <br />RANGEHOOD <br />WATEft HEATER <br />WOO�STOVE <br />METAL FIRE?L/10E E <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />PEflM1T <br />FI.NN CHECH NUMBEH <br />BUILDING <br />PLUA101NG <br />MECHANICAL <br />O7HER <br />STATE 6U�L�ING SURCHAPGI <br />STATEENERGYSURCHARGE <br />PUBLIC WOPKS <br />TOTAL <br />FEE <br />$ <br />M <br />M <br />M <br />FECEIPT <br />PFiOPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />