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� <br /> 1h�EwrprNn A P P L I CAT I O N F O R ���,�„ <br /> °�TM°F CONSTRUCTIOI� e <br /> ever���t PE RM �T <br /> DEPi OF COMMUNITI' DEVELOPMENT $ERVICES <br /> CITY HALL 259-8745 <br /> EVERE7T,\YA98201 [�COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> r <br /> �W�Ervrv�''� � <T. I�lccss��P� ��30� �-�b�,x1 �'���'2�� S��ra� ���-��a7 <br /> �RCHITfCiORDF51GNfR M�RAOONfS$ CILY ZIV VHONE <br /> CENE1SAlC0`�iXA(lOR M,11lA�pfl6S Cliv ZIP PHONF �ICEn5E1 <br /> G�;._ , <br /> HlIHMIUlCOu1RAC10R M�IlA0�N65 U1V LIP PHONE tICENS[I <br /> PIGNIIIVGCONIftACTOR MAIIADDN[SS CIiY ZiP VMONF LICENSEi <br /> (1A55 Of NORK <br /> ❑NEW ❑ADDI'ION ❑ALTERATION �8 PAIR C�DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDINC RELOCATION <br /> 1'iW�ll( �OIN'ORF /� �� � �7 <br /> � � 'G���• ��_ <br /> UlSC0.1B[A40PN � ( � <br /> Fc�c� dafiv.c a s� 2Gx �o ������,�� <br /> reovostousi oi nmiowc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> iFc�o�ca��vOf vqOPFR1Y(SIIOw'+H 10��OP iucr�rouncoc i i PRUVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> ��[�-.� � , � � ���� OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> iur_mocK � /Jor OR NOT. THE GRANTII�G OF A PERMIT DOES NOT PRESUME TO <br /> �L 1 / �/ o G�VE AUTHORITY TO VIOLATE OR C�NCEL THE PROVISIONS OF <br /> /O O/fI'/ �k£,P�D �'PCG��yf`u c /6 ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> /l /7 OR THE PERFORMANCE OF CUNSTRUCTION. <br /> � ...rF �S Y 3„� e�ac SICNATURF Of CONiRACiOR OR AUiHOftIZEO AGENT DAiE <br /> U/ r d / <br /> ioxnnoxess S /IOItO m�5 (���Ll-.(�. y� r' .Sr(�2�-jjY�( X 7// /G/ <br /> a,3 Of Lo m k�tt�f / � - o <br /> PLUMBING MECHANICAL <br /> ' NO. TYPE OF FI%TURE FF[ NO. TYPE Of EQUIPMENT FEE <br /> WATFRClOSET�TOtIET� AIRCO�+D UNITS-MP FA <br /> AATH7U0 RFFNIGkRATION UNIT$-H P EA <br /> uVn70RY�wnSH pASIN� 11JIlERS-HP EA <br /> SMOwFR WS FlRFD A C UNITS-TONNAGE EA <br /> KITCHEN SINK 8 OISP fORCED AIR SYSTE��15-8 T U M F.A <br /> �ISWASMER �M1'�ll MEATERS-U i U M <br /> IAUNDRY TRAY UNII HEATFNS-H T U M <br /> CIOTHES\YASHER E\'APORAiIV[ COOIERi <br /> N'ATER MU7[R CLOTHES�NYFBS <br /> URINAL �'kNilUiION FAN <br /> DRINKING FOUNTAIN RANGF HOOD <br /> FLOOR DRAIN AIR MAN�IINC UN'T— C f M <br /> VACUUM HHEAK[R$ SiOVE <br /> I <br /> ROOf ORAINS—RAINLEA�ERS MFTAL FIHFPUCE 8 CHIMNEY <br /> SINK(SERVICE—NAR. ETC 1 <br /> � SUETOTAL SUlTOTAL 3 <br /> PERMIT f ►FRMIT f <br /> TOTAL FEE 3 TOTAL FfE f <br /> I SIOf YARD 5(Tp.�CK STREET SCTOACK NCnR YARD 5[ipACK PLAN CMCCK NVn19IR PUN�HECK iEE <br /> FEE RECEIPTNO. <br /> USE ZONf LOi AR[A y���NT$li[ <br /> ❑Yf5 �P FFES VAIU�iION iFE <br /> TYP[�LCQNST OCCUPANCY GROUP NU Of OWEILING UNITS <br /> �— � � 3 ' eui�oir�c ���-�v 3Z Sb <br /> sizc or�e�oc � �o or sToaies n+nx occ iono <br /> ZG x yo Z_ --- P���,���� <br /> FIRC ZONE BASFMFNT IIFUROOh15 FlR[ SP0.1NKLkPS <br /> �- � � � REQUIN 1 MtCMANIUL <br /> r - �� C7Yf5 NO <br /> AI�ROVALS !Y DATF OTHER <br /> 1 [NVIRONMfNTALCMECKl15T UBC <br /> PkNAL7y SEC 70)�a) <br /> 7 9UIlDING PLANS <br /> 7 FlRF HYDRANT TOTAL �� ,� <br /> � FIRE PROTCCTION SYSTEM �f11MIT VALIDA710N <br /> WHEN PROPERLY VAIIDATED IIN THIS SPACEI7HIS IS YOUR PERMIT <br /> 5 GNAOINU�%CAVATIONbCIfARINGIGRUIIHING <br /> 1 6 DRAINACE <br /> L. <br /> 7 ENVIRONMFNTAL IMPACT STATEMENT <br /> B HEALTM DISTRICT � <br /> APPLIUTION ACC OY PUN$CHECKFD BV APPN FOR ISSUANCE NY <br /> (,�. � . <br /> 9 b79 <br />� <br />� <br />� <br />� <br />