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` i �. -,. <br />`,-.PPLICATION �CRI_ <br />,^.Ew,°,»° �ONSTRUCTION <br />��r o. <br />eve�ett. PERMlT <br />BUILDING DEPARTMEN7 TO BE COMPLETED IN INK • PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINAT�ON ❑ BUILDING ❑ MECHANICAL <br />•T M�IL �OORESS CIfY ZIP <br />,�w„ , re� ��t,f Go� i �'z 9 �—�i �„� � �i'�-- � Z�o <br />��� ``��� <br />}�5� -I I <br />2 <br />❑ PLUMiiING <br />PNON[ <br />�z —ii(�Co <br />everen <br />� <br />❑ 31GN <br />M��t �o[InE59 cm z�r ruoNE 1l,, `p^' UCYENSE . <br />OENERSLf, NIR�C10 iyL L/vQJ/�AC I I I�-M <br />�� u�`P 7�a'1-►390� g��''a 9SJ19b 5643 —i <br />� MML��OAF�! C��� Z�� PIIONC UCENVE• <br />Mf GUNiC�L GONfH� .!nA <br />VLUMeIN� :ONIH�f.IOA <br />M�il. �OOAES9 CrtV ZiP Pi�OUF LiCE115E • <br />iOf WORM <br />NEW � pDOiiION ❑ ALTERATION ❑ PEF.41R ❑ OEMOLIIION ❑ WOODStOVE/FRPL.�NSERT BUILDING RELOCATION <br />It101�1�51 C{ IA:IUI� US L�BO��� <br />I! fl�l <br />��F�i I <br />R�BE WOPK � .�/ . <br />� <br />VLUINSING <br />WATER <br />DISP <br />' __I ROOFDNams—� <br />� 51NK 15EA'� ICE — <br />ii � <br />� <br />pSE L J��E <br />%�j ' / <br />��vC Ot f,ONS� <br />�N <br />s�rc or oioa <br />9s•� <br />RRE SPRINKLER'. <br />u'.rt1�Ctn09>C� A� <br />AR. ETC) <br />sueror�� � <br />PERMIT s <br />TOTAL FEE _ <br />HEnn5E1B�C/rc S�DESETB�ff <br />f0 � <br />LOIP�ER yACAN1511E <br />�, 53:3 � oNo <br />n[[uon��GYG�OUP NJOFOWEI <br />CLANS <br />1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINFD THIS AF• <br />PLICA710N AND KNOW TFIE SAME TO BE TRUE ANDCORRECT. ALl <br />� PROVISIONSOFLAWSANDORDINANCESGGVERNINGTHISTYPE <br />y� OF WORK WILL BE COMPLETED W!TH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PFlESUME TO <br />' p � GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF <br />�ANYOTHERSiATEORLOCALLAWREGULATINGCOMSTRUCTION <br />�f�THE PERFORMANCE OF CONSTRUCTION. �'� ( o � <br />SI N,�TUPE OF CONiRACiOR OR AUiNO�12E0 AGENT D4TE � 6 <br />�.�. I G G <br />MECHANICAL <br />A/C — �/MNDLO UN�TS — nr. <br />REFRIGERIITION UNITS —HP. EA. <br />BOILERS — B.T.LLM.P. <br />O�5 FIREO A�C. UNITS — B T.U. <br />FOPCED A�R SYSTEMS — B.T.U. M EA. <br />WpLIMEATERS—B.T.U. M <br />UNIi HEATERS — B.t.0 M <br />EV�POP�7IVE COOLERS <br />CLOTMES DFiYERS <br />VENTIUiION FAN <br />RRNGEHOOD <br />WATER HEATER <br />wOODSTOVE <br />METAL FIREPLACE a CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />E%HRUSiFAN <br />sue �or�� <br />PCRM�T <br />70T�1 FEE <br />PLANI;HECKNUMBER IFEE <br />RECEI7T NO. <br />DUILDING ",�' (J' 1 � <br />PLUMBING _�j�t <br />� <br />MECHANICAL � <br />O'HER <br />STATE BUILDING SUACNAAGE <br />SiATEENERGYSUPCHARGF. <br />PUDUCWO�KS <br />TOTAL <br />PROPERIYLOINELOCATIONSANDrFELAEEDE SEMENiSINGAII <br />