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�PLICATION �O� evereY. i <br />'°.E".`°,"" �ON�iTRUC�'!ON 0 i <br />c;n os <br />�verett PERM�T ; <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT � <br />259•861 � <br />❑ DEMOL�TION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />MML ADDRE55 LiTY Zi� PMONE � <br />ow�c,.._ �.�✓in�i�iiflf�J /r,T'� iiiiYll?!!/iY: ��i/-61.�� U�� v�-`'-Z'C'1�?� _ , <br />�rr��� ��rv p�p PHONE LICENSE � <br />G[NERALCONiRAGqiOR MPILAOORE55 ' <br />MECIIeNI�NiP�Gi� M�tLA00RE55 Lltv LIP FNONE LIGENSE• ., <br />i <br />PWMBINGCON1PAGtON � MAIL�OORE55 C'�Y !i�' P��ONE LICEMSE• ' <br />� or wc�K <br />NEW ❑ AODITION ❑ A�TERATIGN ❑ REPAIR l� DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING FELOCATION <br />iTIONOFWORNICOSTOFMAt[RULS�'LUSLPOOA� }�� <br />�.,..�� �D�D- ��. <br />nooaEss <br />PLUMBING <br />WATER CWSET �TOILI <br />BATHTUD <br />UVATORY(WASHBA'. <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />�YASHER <br />DRINNING FOl <br />FLOOR ORAIN <br />ROGF pRAINS — I <br />ciuY iSFRVIfF � <br />faONiSEi��Cn <br />USELONE <br />R-z <br />' ^F COrvST <br />�/f2 � <br />Si2[ OF BL00 <br />RInCL 0� <br />�-�� <br />SUBTOTAI. s <br />PERMIT s <br />TOT�LFEE = <br />ao � <br />:OiRREA <br />G�SOO <br />O.:Cl1PANGY GI <br />M-� <br />NO OF SLORIE'� <br />i <br />I HEREBY CERTIFY THAT I HA'JE READ AIJD EXAMINED TI�115 NP- <br />PLICATION AND kSNOW THE SAMETO BETRUE AND COFRECT. ALL <br />PROVI310NS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK N�ILL BE COMPLETED WITH WNETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULNTING CON�TRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATUFL OF GON1 C OP O AUTNO��ZED HGENi ❑�TE <br />� A�ili � %� 7%�/I/J'�� � �� � <br />MECHANICAI <br />FEE NO. TYPIi OF EOUIP! <br />qrC — R�NNDLG WVITS — H P. <br />FEFR!GEPATION VNITS — H P. F <br />BOIlEPS — P.T U /11 P. <br />GAS FIliED.��Q UNITS —B.T.U. <br />FOACED nIR .`.YSTEM$ — BSL. <br />WALL tiEATEPS — B.1'.U. <br />UNIT HEATEPS �- B.T.U. <br />EVAPORATIVE COOL E�75 <br />CLOTHES�RYEPS <br />VENTILATION FAN <br />qANGE1i000 <br />WATEHHEATER <br />WOODS70VE <br />MEfAL FIREPLACE d CHIMNEY <br />FIREPLACEINSERT <br />HFATPUMP <br />GAS P�PING <br />EXHAUSTFAN <br />SIOE SEiBAGN <br />C 1 <br />NO OF OWEII�t <br />� <br />M�%ALG LO�[ <br />N� <br />MEGNEDBV IAPPq fGRi55U�NGEPY <br />`� -L G_"�_ <br />PLAN CHECKp UMBEH <br />��/ I S�G <br />FEE <br />M EA. <br />M <br />M <br />iUBTOTAL s � <br />FERMIT f <br />TOTALFEE s <br />I FEE� _ � n I AECEIPT NO. <br />i �.��' �rcl �n � <br />BUILDING <br />PLUMBING <br />MECHANIC�IL <br />OTHER <br />STATE BUILDING SURCNANG <br />STATEENERGYSUFCHARGE <br />PUBLIG N'OFlKS <br />TOTAI <br />F ROPERN OP✓NERS ARE RESPONSIBLE FOR DE7ERA11NINGl.Li <br />i=NOPERTY LINE L�ICATIONSAND RELATE� EASEMEiJTS. <br />