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APPLiCAT10'-' FOR CONSTRUCTI'�N PERM1�' �✓.�" <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: �.j GAS ELECTRIC .J <br />BUILDING DEPARTMENI" <br />259-8810 <br />� DEMOUTION COMBINATION ! i BUILDING i7 MECHANICAL G PLUMBING SIGN <br />,,,.,.,� ._ ..�, <br />TENANT <br />MAIL ADC�ii[55 <br />l.111 LI✓• <br />%CO`� L�c:�//i�'c�.DF �l'�/'E <br />cin zia PHone <br />a�a 3 �"7/ <br />AqCHdEGTORpESIGNER R141LADDRE55 CITY ZIP PHONE <br />GENERALCONTRACTOR IdRILA0DRE55 CIiV ZIP PMONE STATELICENSEI <br />MEGHANICALGONiRACTOR IdARAD�RE55 qTY ➢P PNONE StATELICENSEe <br />PLU�A9INGCONTFACTOR MAILAODRE55 CITY ZIP PHONE STFTEUGENSEx <br />CONTRRCT PRICE OF WORK <br />PFOPOSED USE OF BUIIDING <br />LEGAL DESCRIPTION OF PROPERTY �SNO WN BELOW OF ATTACH TWO COPIE51 <br />LOT / � BIOCK L•�.' = OF <br />,s;,; -G'c�� -O/S- ]oo <br />PARCELTA%ID.NUMBER <br />CONSTRl1Ci:ON LOAN LEPAER. AODRE55. TELEPMONE NU6��EP <br />PROJECTADDRESS <br />TY!'E OF <br />LAVATORY�WqSH BA: <br />SHOWER <br />KITCHEN SIrJK 8 DISP <br />CLOTHES VIASHER <br />URINAL <br />DRINKING F OUNTAIN <br />FLOOR DRPIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIIJS—RAINLEAC <br />SINK ISERViCE—BAR. ET( <br />FOR OFFICE USE ONLY: <br />FfiONiSETBACH flEARSETBACK <br />USE 20NE lOT APEA <br />iYPE OF GONSi. <br />SRE OF BLDG. <br />OCCUPANfYLOAD <br />INTAKE BV <br />SUBTOTAL 5 <br />PERMIT i <br />TOTALFEE S <br />FIRE SPPINK�ERS REO'0 <br />flRE ALARM REOD <br />PLANSAPPROVED <br />DFTE <br />FEE <br />-3F '7 <br />I HEREBY CERTIFY THAT I H1VE READ AND EXAIdINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE O(' <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM UTHORIZED 6Y THe <br />OWNER OF THIS PflOPERTY TO PERFORM TH WURK FOR WhIICH <br />APPLICATION IS MADE AN� I G.QMPLY ITH THE STATE <br />1� <br />scHaunc <br />UtV OU51�:! SS IICENSE <br />TYPE OF <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS <br />4ENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />INOOD STOVE <br />MFTAL FIREPLACE (WOOD BURNING) <br />FIR�PLACE INSERT <br />I1EAT PUMP <br />SI�ESETBACN PIANCHE KNUMBER FEE <br />S�_ <br />VALANT SI7E FEES <br />?_� YES �l NO Bl11LDING <br />occuo.ucr xa o�mvewrcuxns <br />�"�1° PLUMBING <br />BASEMENT MECHANICAL <br />-1 YES � ; NO <br />HEiGHT uMtTnT1oN ADOITIONAL PLAN CHECK <br />OTMER <br />SThTE BUILOING SURCHARGE <br />CITY OF EVERE7f Pl1BLIC WORHS <br />LOCALSALES <br />1'AX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE 5 <br />H[CEIPT NO <br />VALUATION FEE <br />�^� �— <br />/ __' __—� <br />i <br />� <br />_ ""_ "'�T_ <br />� _ _ 1�Y <br />