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If1I Ev�rp/Mn <br />cirr or <br />ev�rett <br />BUILDING DEPARTMENT <br />259-881 tl <br />�r.PPLICATION FO�� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />ereretl <br />� <br />O DEMOLITION ❑ COMBINATIQN � BUILDING O MECHANICAL O PLUMBING ❑ SIGN <br />pWUCR M�q�DDRE53 G1Y Iln pMONC <br />,Tvs� /t�,.„,—,� )/L. L?,-ria,. �?. Ci,e�RE�, (.�'l-1. y5%O, iS�-Gs�/. <br />1PCNIIEC� ON Or Si6NEN Mq� �ODRE53 CIIY I:P pHOHE <br />/'� <br />G6��ERAI CONINSC�OR Mql AOURE55 ' QfY ZIP o���NE LICENSE • <br />MCCII�NICcJC(JIIIqIf.fnq M�I�A�ONE55 CIIV / ZIp 1�110:lE � / �I[[ry[�• <br />>W MBINO GOYI MAIL �D�RE55 ----/-rLI�U �" F/ tl d i-IJ P1�1 <br />GIIY Zli' PIIvNE IICE�15E • <br />CL�SSOf WOR✓, <br />�' NEY/ C� ADORI04 ❑ ALTERATION ❑ REPAIR ❑ DEMOLIT!JN ❑ WOOD:TOVE/FRPL.INSERT ❑ BUILOING AElOC41�ON <br />v� W�*�on or wo�� �cost or �.utEninl`s rlus LeaoN � -� - <br />�CtiL'(R?cl ��55fL�C.�J�) <br />DESCNiBE WOAe <br />io•._ oioc�_ <br />PI_UMBING <br />N!�. � 7VPE OF FIXTURE OR ITEM <br />—� wATEP CLOSET ITOILEi� <br />BATH7U9 <br />LAVATORY�WASHBASIN� <br />SHOWER <br />KITCHEN SINN 8 OISP. <br />OISHWASHE(i <br />LAUNORYTRAY <br />CLOiHES WASHER <br />URINAI <br />DR�NKING FOUNTAIN <br />FLOOI bRAIN <br />ROOF ORAINS - HAINLEApERS <br />SIWK �SERVICE -OAR. ETC � <br />�Nplll$EIBFCN �.• <br />7oi <br />US[ ZONE <br />�- 1 <br />r.rE n__Lp•`Si <br />.f / � <br />S4E Of BI DG <br />/%lv Jl� /1: <br />i1LC�1�:��lOY el:'_ <br />�� <br />SUBTOT�L <br />PEPMIT <br />TOTALFEE <br />��E4R SEIQACR I SIpE 5f19/6N <br />7�.' G ' <br />R-3 <br />u0 Of S�ORiES <br />� <br />VACAII� It[ <br />❑VES NO <br />NO OF DWFILING 11NIi5 <br />/ <br />� <br />/�- � �- � C <br />er <br />i HEREBY CEHTIFY THAT I HAVE qEAD AND EXAMINED T�11S AP� <br />PLICATION AND KNOW TIi E SAME TO BE TqUE AND CORRECT. ALL <br />PRCVISIONS OF �AWSAND ORDINANCES GOVERNING TFIIS TVPE <br />OF WORK WILL BE COMPLETED WITH WIiETHERSPECIFIED 11EFE� <br />IN OR NOT. THE rRANTING OF A PERMIT L�pES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSiRUCT10N <br />OR THE PERFORMANCE OF CQNSTFUCTION. . <br />SIGNATU�E Of CONIRAGlOR OR AUfNOR�ZEO AGENT �qiE <br />X <br />NO <br />MECHANICAL ^/�;.�,�_ <br />TYPE OF EQUIPME <br />AIC - AiHNDLC UNITS - HP. <br />REFFIGERATION UNITS - HP. EA. <br />80:LER5 - 0.7.U.MP. <br />GAS fIRED A.C. UNITS - H.i.U. <br />FORCED AIR SVS'fEMS - D.T.U. <br />WAII NEATERS - BS U. <br />UNIT HEATERS - BSL. <br />EVAPORATIVE :OO.ERS <br />CLOTHES�RVER9 <br />VENTILAiION FAN <br />RANCE IIOOD <br />WATER HEATER <br />WOOOSTOVE <br />METAL FIFEPLACE d CHIMNEY <br />FIFEPLACE INSERT <br />M=AT PUF1P <br />GAS PIPING <br />E%HA�ST�..N <br />SUBTOTAL <br />PERMIT <br />PIAN CHEC NUMOER <br />IFEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARG <br />STATEENERGYSURCHARGE <br />rueuc wonKs <br />TOTAL <br />FE� � / �) HECEIP��� <br />lD / <br />� <br />PROPERTY O W NEf75 ARE RESPONSIBLE FOR DETER611NING ALL <br />PFOPERTY LINE LOCATfONS AND RELA7ED EqSEh1ENT5. <br />