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� nPPLICATION FOh ���,�„ <br /> '".`".,°`"" COPISTRUCTION �i <br /> CIIY 0� <br /> ev�rett PERti11T <br /> BUILDING DEPARTMEN'I <br /> ?59•8745 TO @E CONIPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL O PL'JMBING O SIGN <br /> OWNIn MeRA0DRE55 CII' 2iP P��O��[ <br /> l� �11 L�I �� ('� � ��C�I� �f-111' - ����)l'`,�, �QYIIk.Y�ul(:Q , i 1 �'L + �jli,),l '� %�r��l� �.):_.l I� G <br /> enumcc�anocsione M�a�ooness ein i ziv P��ONE <br /> crrrtnueornnee�on eau�eooness an nr r�ronc ucer�xe• <br /> !�(-�'t��. (� Fll �:f�S ��i�11��� Il(�i���1�� .1-�I�l��f,(� ��ic��'����1' is "� , ,'��i,5�.)'���I— I.'i�7�.�f'(:1. ;?,>1 <br /> AILC����Ii44CONt�ACIOq ` M�IL�D011ESS CIIY ZIP fN0lE LICEISE V�I <br /> ! <br /> 1�`'lll <br /> nuuomncornnecion M�i�Aooness eirr ziv ��w�+e ucer�sc. <br /> �,y�„ -r <br /> ttnss Ur wonK <br /> ❑ ��EW ❑ A�OITION O AITERATION ❑ REPAIR ❑ DEIAOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING F7ELOCAIIO�t <br /> VelU��iO��Of WO�M IC091 O�A��I[nUlS i'W9 t�D0A1 <br /> m scnme wonK /�/�, /� p • n, <br /> �����.���.�.:� 1 "� 1�� ��L- _ L�" �_lt ��i'�� I��� t,l'1 �w�����:. ������� . <br /> usi.or nuamun {, U i HEREBY CERTIFV THAT I HAVF READ AND FXAMRJFp 71IIS AP• <br /> C.Il,�,��C�l PLICATION AND KNOW 7HE SAME TO BE 711UE�ND CORRECT.�lL <br /> ieauo[scmrnariornnoremrisr�owNee�owon�new�rouncaries PROVISIONSOFLAWSANDOf7DINANCESGOVERMNGTIi�STYPE <br /> OF WOf1K WILL BE COMPI.ETED WITH WHETI IEfi SPECIFlED I IERE <br /> io�—owcK—or IN OR N07.Tf-IE GRANTING OF A PERMIT DOES NOi PRFSUME TO <br /> GIVE AUTFIORI7Y TO VIOLATE OR CANCEL THE PROVISIONS Of <br /> ANV OTFIER 5lATE OR LOCAL LAW REGULATING CONSTf7UCT1UN <br /> — OR THE PERFORMANCE OF CONSTRUCTION. <br /> $IONAIURE OF CONfRACTOR OR AUTIIORIZEO AGCtli OAIE <br /> X ���1�� t_r� '�1i '� /���T <br /> rnaec�+onness . nrruc�r+rscirveusu+essucEr+ser�o. <br /> =�-1-171L. <br /> PLUMBINO MECHANICAL _____— <br /> NO. TYPE OF FI%7UPE FEE NO. TYPE OF EOUIPMENT FEE <br /> WAtERCLOSEi�TOILETI AIRCOND.UNITS–H.P.EA __ __ <br /> B�iHTUB flEFRIGERAiION UNI75–N.P.EA. __ _ __ <br /> LAVA10iiY1WA51i BI151N1 OOILERS–H.P.EA. __,_. ___ <br /> SIIOWE� - GAS FIRED AC.UNIiS–IONNnGE EA_ ____ <br /> KIICHENSINKB�ISP. fORCEOAIFSVSIEMS–B.T.U. MEA _ __ <br /> _–_– DISIRYt.SHER WALLHEAIERS–B.T.U. M – _ <br /> �AUNORYTqAY UNi�HE�TE�S–B.T.U. M _ ___ <br /> CLOi11ES WASHER EVAPORNNECOOLEFiS ____,__ _ _ _.. <br /> \YAIERHEATEfI _ _ CLOTIIES��YERS ____— _ _._ <br /> —�— ---- <br /> URItlAL � VENTILATIQN FAN —_ <br /> Df11NKINOFOUNTAIN (iANGEl1000 _— -- <br /> FLOOP ORA�N _ AIP IIANOUN�UNif— QF.h1. ____ '__ <br /> VACUUM UfiEAKEf15 STOVE --- <br /> ROOf DtiAINS—RNNLEtDEf1S METAL FIHEPLACE d CHIMNEY __ ____ ___ <br /> S�NKISEFlVICE-0��.E(C. _ WOODSIOVE/F�REPLACE INSGRT ,_ __ <br /> -- - (��nV, �;�ck'ttdA' 1<<yi�it .— -- <br /> SUH TOTAL SUB TOiAI f _ __ <br /> PE1iM�T S PEfIMI( S _ ___ <br /> TO'ALFEE 3 70TALFEE s _ <br /> THIS PORTION TO BE COMPLETED BY BUILDIN� DEPT. PER50NNEL <br /> rnpNI5El0ACK �E405EIOACN SIOESF]BACK PIANCNECRNUMBEII PUNGnE6`.�E' <br /> fEE fiECClI`I NO <br /> tl5f lUHE ���p�E� VACANf SIIE — VALU�t10N PE� <br /> FEEB <br /> OYES ONO <br /> IVPEOfCONSi OGW�ANCYCf10UP ��D.OFOW4Lll1l3UNIfS <br /> BUILUINO f <br /> S�if O�plOU ��O Of SIOf11E9 M�;OCG L0�0 <br /> PLUMBINO <br /> MECI1nNIC�L _ <br /> FIfiE SPfiINK�EfiS qE0UIf1ED ❑YES tl NO <br /> OTIIER <br /> PENALTV <br /> �PPIiC���O�i�CC BY �UNSCIIECNEOBY �PPR.FORISSUAHCEOY <br /> TOTAI <br />