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- 1 - i <br /> r;� .: ,;�;� -: <br /> � ApPLIC.+T10N FOR CONSTR�t,CT10N s�� ° <br /> ��. � <br /> PERMIT �, <br /> C�CICII �' <br /> EvarOrean � �':. <br /> Y OF <br /> �verett ��� <br /> IILDING DEPARTMENT <br /> ,�.8810 TO BE COMPLETED IN INK— PLEASE PRINT ', <br /> Mnu on[ss an zm ruor�e � • <br /> �,<<�` ��GU�/1�c��9( �`'GGt�GY��ir �/a-t � ��39( �'S�f��/(� ! �. <br /> ��C �/� cliv ]�r PNON[ •1 <br /> •� � H�j MNL�OORE55 � <br /> ��. <br /> V PIIONE � <br /> Q MAILADD�E55 ��TY Z�P <br /> p�1�ECT OR OESi6NEn � <br /> �y� <br /> Ctir im ��IDNE uc[NSE• <br /> �� � N[11AL WNiRI.G10N IAAIL�OU�[SS ' . <br /> ��� MAIL�OOR[55 <br /> G1Y 21P PNONE LIGENSE• � <br /> �r,NANIGKGOHIPAC1011 ( ' <br /> � Z�p PNONE LIGENSE• �� <br /> ❑IA91N6CON1B�C10R <br /> MAII�DDR[55 ��t� � <br /> �� o� ` <br /> �ASSOf WORQK <br /> Q(�ty ] NEW pi AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFPLINuEf1T ❑ BUILDINOPE�OCATION <br /> GONI/.CT VERSON ANO PIIONE NO <br /> W � qp1111M1'ROVEMENLORIMERIORREMO�EIONLY �' � �� /�� Q�('y� �/L� <br /> � Q � Ily <br /> M �1N111�Ci�RICE OF WOHK �//} <br /> �y �SGNBEWORR�NPSOWREFOOIAGEINWWED �/ <br /> M• . <br /> fq novosEouseo�aunort+ 1l1EPEBVCERTIFVTHATIHAVEREADANDEKAMINEDTHISAPPLICATIONAND <br /> ��� ��—�`��� KNOW7HESAMETOBETRUE�NDCORRECT.ALLPROVISIONSOFLAWSAN� ��� <br /> ORDINANCES GOVEFNING THIS tYPE OF WORK WILL BE COMPLETED Po�TH � <br /> � � fC�LOE5C91P110NO�PRO enrrisr�owr+ E OWORARAGNfOURGOmE51 WHETHERSPECIFIEOHEREINOqNOT.THEGRANTINGOFAPERMITDOE5N0T <br /> PRESUMETOGIVEAUTHORITVIOVIOLATEORCANCELTHEPROVISIONSOF � <br /> � p� B�ocr._._ oF ANYOTHERSTATEORLOC�LLAWPEGULATINOCONSTRUGTIONORTNEPER- <br /> � FORMANCE OF CONSiRUCTION.THAT I AM AUTNORIZED BV TIIE OWNER OF <br /> .. .`. " ANDPRCOMP VTWIlE1�1HEM5TATE CON7RACTyORSHLAWL102T7�RCW AND <br /> 296200�NAC. �`�����q <br /> S�GNAIU�EOPCONIRRLIOROIIAU�H0912EDAGENi ��lE � <br /> X ,,.,,�� <br /> �f10J[CtA00R[SS AP I ANi5G1iVBU5W[SSLIG6N5[ O.ANDOUSWESSN�ME <br /> 5(o I /— tf' � <br /> � MECHANICAL <br /> �� PLUMBING FEE <br /> i � � N0. TYPE OF FI%TURE OR ITEM FEE NO. T'PE OF EOUIPMENT I <br /> IC�, __ WATERCLOSE7�TOILET) _ NC—P/HNOLGUNI7S—H.P. <br /> , �� FORCE�AIR SYSTEMS—B.T.U. M EA � <br /> BATHTUB — <br /> �.1 � — LAVATORY�WASHBASIN) _ — UNITHEATERS—BT.U. M i <br /> ISHOWER CLOTHESDRYERS I <br /> I �� -- _ VENTILATI04 FAN — �� <br /> ` KITCNEN SINKB�ISP. <br /> � DISHWASHER _ PANGEHOOD I <br /> I LAUNDRV TRAY _ WATER IIEATER — <br /> WOOD STOVE <br /> ' CLOTHES WASHER _ — <br /> METAL FIREPLACE 8 CHIMNEY — <br /> � I _ URINAL -- <br /> �_ FIREPLACEINSERT <br /> pRINKING FOUNTAIN — <br /> FLOOR DRAIN HEAT PUMP I <br /> � BACKFLOW PPEVENTERS _ GAS PIPING � <br /> ROOFORAINS—RAINLEADERS __ E%HAUSTFAN — i <br /> i �� SINK(SERVICE—BPRE7C) — �'' <br /> I' '_1- _ � <br /> I SUBTOTAL E SUBtOTAL a i <br /> — PERMIT s <br /> PERMIT S _ — �� <br /> � TOTAL FEE S TOTAL FEE s <br /> �� FEE PECEIPTNO. <br /> 11i0NI5El0�GN P[�ASElOALK <br /> SIO[SC10nCN PUNGNECNNUMOEN <br /> us[zoe+E �areae� VAG�NI511[ FEES VALUATION FEE <br /> p YES ❑NO I <br /> DUILD�4G — i <br /> ttCEOFCONST. OCLUPANCYO�OIIP NOO�OWElLIN4UNl13 — <br /> AILOWAOLE/�GiWI PLUMBING <br /> saeovaioo. No.oFstom[s �sYc xG�O�u MECHANICAL — <br /> ns <br /> NEIGIIIUTAIqiION OTHER -- <br /> rmEsrniNK�msneou�neo ❑res or+o _ StATEBUILDINGSURCHARGE <br /> STATEENERGYSURCNARGE _ , <br /> i <br /> /,PPLIC�110NA6LOV FUHS/.PPR.AY PUBLICWORKS �, <br /> TOTAL <br /> � ' <br />