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S,cf�PLICATION FO1:,� "'���5(y.U�'"nDi'`���,�„ <br />��r�'°`"^ CONSTRUCTIOfV ti�° <br />everett PERI�IIT y.2�5-haR� � <br />BUILDING DEPARTMENT <br />259•8810 TO SE COMFLETED IN INK- PLEASE PRINT <br />❑ OEMOLITION ❑ COMBtNATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />OWNEP � J MAI�AODPESS CITV ZIP � PNONE " ' � � � <br />Gt� � f( /l>�c9 C / fl/3 ����t� 4� �'�a.�� 91''2 0 3 3 S'3—S'v7/ �, <br />ARCXI TOROE910NEP MMLApORE33 Cltt ZIP PMONE <br />OENEMLGONTR�GTOF MMLAOOHES9 C��Y ZIP PHONE 4CENSE• <br />��[a ) n a r <br />MECH�NIL�LCONTP�CTOq M�IL�OOHE55 GttY ZIP � PNONE � - 4CERSE• <br />PWMBIHOCONTR�CTOR MAILADDNE55 CITY ZIP PIIONE LICENSE• <br />CL�950F WOPK <br />❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />� <br />PLUMBING <br />No�— <br />WATER <br />LAVATORYiWASHBA51N1 <br />SMOWER <br />KITCHEN SINK 6 OISP. <br />OISMWASHER <br />URINAI <br />DflINKIN� <br />ROOF 6iiAINS - RAINLEADERS <br />SINK �SERVICE - BAR. ETC.) <br />iROhT$EiBACN ' <br />�• <br />USE 2pt� <br />`K i <br />ttPE OF LGNST <br />�� � <br />s¢eora�oo. � <br />�Zo SF �' <br />49-0 5'F G � P. <br />�d O <br />SUBTOTAL f <br />PERMIT f <br />TOTALfEE f <br />FERR SET9�CK Si�E SE <br />zo' c <br />LOTAREA ... <br />R-3 <br />STOHIES <br />1 <br />� <br />�l.4 <br />wvpLIG0.TIONnGQBV PUNSCNECKEDBY APPR.FOPISSU�NCEBY <br />� / ✓� � <br />.,r... . .__. '_ _ _ _. <br />Js�. ... . . . . . . . . . .... . . . .. . ._ .. _ -: \.�:_ �:�. <br />I HEREBY CERTIFY THAT I HAV[ READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TOOETRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHIS7YPE <br />OF WORK W�LL BECOMPLETED WITH WHETHERSPECIFIED HERE• <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOT PRESUME TO <br />GIVE AUTHORI�fY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER S7ATE OR LOCAL LAW R�GULATING CONSTRUCTION <br />OR TFiE PERFORMANCE OF CONSTRU�TION. . <br />SIGNATUREOFCON1.iACTOHORAUT RIZED ENT UATE <br />x-'`�� ��iv� y-z -a� <br />iPP4CFNT CITY USINESSUCENSENO <br />PAECHANICAL <br />A/C - A/HN�LG UfJ1T5 - M.7. <br />fiEFRIGEPATION UNITS - H.P. <br />001LER5 — B.T.LLMP. <br />vna nncv n.a.. vni i a— o. �. <br />FORCED Alq SVSTEMS — B.T <br />WALL NEATERS — B.T.U. <br />LINIT MEATERS — B.T.U. <br />CLOTHES DHYEPS <br />VENTILATION FAN <br />Y/OODSTOVE <br />METAL FIqEPLACE 8 CHIMNEY <br />FIFEPLACEINSERT <br />NUMBER <br />� <br />SUB TOTAI. <br />PlHMIT <br />BUILOING <br />PLUMBING <br />MECHANICAL <br />O7HER <br />STATE BUILDING SURCHAFG <br />STATEENEAGVSURCHARGE <br />PUBLIC WORK3 <br />YOTAL <br />M <br />M <br />M <br />FEE <br />S� � <br />VALUATION <br />5�-,.� � �� <br />REC�� � � �� <br />PRO?EflTY OWNERS ARE RESPONSIBL'e FOR DETERMINING ALl <br />PROPEFTY LINE LOCATIONSAND RELATED EASEMENTS. <br />�� <br />