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� <br />APPLICATION FO�� <br />'".E"'°`"° CONS�RUCTIOfV <br />Qr �F <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8870 TO BE COMPLETED IN INK • PLEASE PRINT <br />� <br />��f%c{ (/a{. ���/ � � � %Od <br />���rcn <br />e <br />❑ DEMOLITION ❑ COMBINATIQN BUILDING � MECF'.ANICAL ❑ PLUMBING ❑ SIGN <br />OWNER M�IIADDPE55 CiiY ZiP PNONE <br />�,4v�� �Hij'E d'f D� .h,g��vdci� �'v�'�'�TT 9g,�o3 3 y1- /.: 97 <br />�FL�uiECTORDE5IGNER M�iL�00PE55 CiTV ZIP PNONE <br />��H,,(.sa�y,��.�.. <br />i�FNER�LCONTHACTOF M�IlA00RE55 CiTV LiP P��ONE iICENSEJ_� <br />AL /NA �FL iS'GAbS /71 Y COGE E,�U�I�1cLAlv 9POZL ,g�zt�7v8 <br />�MECnANIC�LCONTRaCTOfl MAILA�ORESS btY 21V PNONE UCENSE/ <br />PIUMB'NGCONLRaG10R M�iL<D�RE55 CiiY bP PIIONE LICEI6E� <br />� NI.JJ ❑ A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FflPL.INSERT ❑ BUILDING RELOCATION <br />VA� WTiON OF WORN�WSi Oi MAiERIALS PWS LABONI ,,��/ <br />yPa!_ /_�' f14/L /�/ A// '�t�l7 - � /� 70l) <br />oesca�ee woaK <br />USEOFBWLD�G` <br />7 <br />lEGet OESCRiPTIJ <br />LOI_ BLOCK <br />//`j/�`i% <br />v � �� <br />6y o� <br />PFOJEGTADOHE55 <br />PLUMBING <br />ITFM <br />WATEP LLOSET �TOILET� <br />BATHTUB <br />UVATORV IWASM BASIN� <br />SHOWER <br />KITCHEN SINK 6 �15P <br />DISHWASMER <br />UUNDRYTRAV <br />CLOTHES WASMEN <br />URINAL <br />ORINNING FOUNTAIN <br />FLOOR ORAIN <br />. — BARLETC.) <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />IPONiSETBACK RERflSETBRCN <br />�j� / / <br />Ly! � o <br />�-Z ��a,��o5� <br />P[OFCONST OCCUPANCYGROl1P <br />I � _ <br />2E Of BIOG NO. Of STOPIES <br />OC� � <br />BY <br />SIOE SEIBnCK <br />— {/ <br />�] <br />VAL�NT SIiE <br />OVES i]NO <br />NO OF DWELIING UNITS <br />MR% OCC L_=N0 <br />.,rop. Foe issw <br />/ �"� <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE 7RUf_ AND CORREG7. ALL <br />PROVIuIONS OF LAWSAND CRDINANCESGOVERNINGTFIIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER 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 REGULATING CON6TRUCTION <br />OR THE PERfORMANCE OF CONSTRUCTION. . <br />SIGNATUBE Of GONTPnGTOR OR AUTMORIi:ED AGENT f7ATE <br />X /f19n_%r,�.t .�� %l/�lr.r��.. 3 - 9- AR <br />MECHANICAL <br />FEE <br />A/C — A/HNDLG UNITS — M P. <br />HEFRIGERqTIOM UNITS —H P. EA. <br />BOILEFS — B.T.0 M.P. <br />GAS FIPED A�C. UNITS — B.T.U. <br />FORLEO AIP SYSTEAiS — B.T.U. M EA. <br />WALL MEATEFS — B.T.U. M <br />UNIT MUTERS — B.T.U. M <br />EVAPQRPTIVE COOLERS <br />CLOTMESOFYEflS <br />VENTIIATION FAN <br />RANGEHOOD <br />wOO�STOVE <br />MEfAI FIREPLACE d CNIMNEV <br />FIPEPLACEINSERT <br />HEATPUMP <br />CAS PIPING <br />SU0TO7AL <br />PERMIT <br />TOTALFEE �_ <br />PLAN CM CH NUMBER FEE RECEIPT N. <br />�s�s �Iq�9 � � �� �S G�`�GY� <br />aui�oim3 5 <br />PLUMBING <br />MECNANICAL <br />OTHEfl �'��(�Pflt � �;3 <br />STATE BUILDING SURCHAfiG <br />STATE ENEP(;Y SUflCHAPGE <br />PUOLIC WORKS <br />TOTAL <br />�S <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINI <br />r'ROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />