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�:::�PPLICATION FGt1 <br /> '"'E"'°`"" CONSTRUCTION �`e <br /> CItY OF <br /> evere�t PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INY• ^LEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER ����LApDflE53 �J GITY 21V PHONE <br /> � II ,�� s/�(x/ N-G AP� L�.E' /J���P]lu� _ <br /> •pCH� Ct011DE5iGNE11 M�II�DORE54 GItY 21F PHONE <br /> OENER�L CONiR�C10R M�IL�UDRESS Cltt 21P VNONF L�CENSE• <br /> ��Te [yi� 8�i/ �/a+s�s� . �•f-,Z}� tT SuJ �n7.Ir�L_f'rtoli S�da o5�ic sTa7� /y�/�/ <br /> IAEL���NIULCOHiIUCfpq / M�IL�D�R�SS � GfY LIP PIIOHE UCENSE• <br /> PIUMBINOCONTP�CIOR M�ILApDRE54 GIIV 21P PHONE UCENSE� <br /> G1�550f WORr. <br /> ❑ NEW ❑ ADUITION � ALTERATION ❑ PEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br /> V�LU�T�ON OF WORn�COSI Of Met[RULS CW 5 L�80R� <br /> +�`T�J1��� __ _ __ �}S.2n <br /> DESCRiBE WORN <br /> -- S i r <br /> useorewioiNa I HEREBY CERTIFY THAT I HAVE READ ANU'EXAMINED THIS AP• <br /> ,1�!-Y_'iGc= �U/9 � - � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.AII <br /> lE0�L0E5CR�PiIONOiVPOV 1YIS�.OwNBELOWOR�tt�C11FO11RCOPIE51 pqOVISION50FLAWSANDORDINANCESGOVERNING?HISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE• <br /> iot—e�oc�_ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL lAW REGULATING CONS?RUCTION <br /> OR THE PERfORMANCE OF CONSTRUCTION. �/ . / <br /> SIONATUREOFCONTRACTOAOR�UTHORIZEDAGENi 047E �y�[LC� <br /> I � <br /> — =2 _ N X . �.� <br /> PROJECt1pORE33 �PFLIC� SC BUSINESSL�CENS O• <br /> ��Od /= — <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FCE <br /> WATER ClCSET�TOILEn A�A COND.UNITS-N.P.EA. _ <br /> B�TNTUO REFRIGERATION UNITS-H.P.EA. _ <br /> LRVATOPYIWASH BASII�I L� BJILERS-H.1+.EA. <br /> SHOWER OAS FIRED AC. UNITS-TONNAGE EA <br /> KITCHEN SINK 6 OISP. FORCED AIH SVSTEMS-B.T.U. M EA. _ <br /> DISHWASHEH WALI HEATERS-B.T.U. M <br /> LAUNDRY TfiAV UNIT HEATERS-B.T,U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEO.;ER CLOTHES ORVERS <br /> f URINAL C1D VENTILATIONFAV <br /> OFINKING FOUNTAIN AANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BP.EAKERS � S70VE <br /> ROOF DRAINS-RAINLEADERS METALFIREPLACEB CHIMNEY <br /> SINK�SERVICE-BAR,EIC. WOODSTOVE/FIREPLACEINSERT <br /> SI1B TOTAL SUB TO7AL S <br /> PERMIT f PERMIT S <br /> TOTAL FEE S �Z U TOTRL FEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> 'RONt5E7BRCN REARS[lO�CN SiDESETB�LK PI�NLNFLttNUMOEN (� PIANCN5CKfEE <br /> �`� ^• �� � iEE —llQ� RECEIPTN079�57 <br /> I! �� <br /> JSE2CNE IOt�PEA y�CANTSRE <br /> C�/ �,a OYES 7QN0 FEE9 ���V�iION LEF <br /> ryoEOFCONSf. OCCU�aNCVGnOUP NOAFUWELLiNOUNITS <br /> �'N �3�2 D ewioiNa st�r •� �((� �,� <br /> "RE� dLDO NO OF S10RIE5 MR1[OGQ IO�D <br /> �� SG %//�fdR �� �- /(oC��rc 3Z PLUMBING (Z p <br /> MECl/RNICAL <br /> ri�E SPRiNKLEFS REOUI�7ED ❑ tES SO NO <br /> orHen <br /> PENALTY <br /> Prl�Cp110NeCC 9v PL�HSCIRCHEDOY �PPR.FORISSU�NCEBY --- —'l— <br /> TOT�L G ZZ SV <br /> ��, ,� J� � . � . - <br /> � <br />