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;��everett <br />BUILDIN(i DEPARTMENT <br />- 26WBB10 <br />' �i��, <br />'-i. IEP <br />`v����/i...✓� � <br />MN1T <br />..�i. '2t:G..« <br />���' -NK7XITEGTONDEBIONER <br />yqY:� . <br />APPLIC�ION FOR CONSTR �'� TION <br />PERMIT <br />� <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />everett <br />e <br />PMONE � <br />�20 3 ' �s'2�^d�O 6 <br />PHONE <br />, � �I. 1.Iihj �l � <br />PMONE ' � �,r <br />PMONE LICENBE� ' <br />rA'- 8'so �j . .. <br />MONE LICENSE• <br />f,.�,,,�R.,�,.,,,.,�,,,.,,,� _..,���.���� __ _ K <br />� '' - 3S i'%�1�2L.(.�. <br />��' R{IMM GONTMCTON MML�ODPESS CITY 2IP PMOhc <br />!��..,� � .�'�.�'0.�.,.�.�1� <br />.� cuuawomc o <br />❑ NEW ADOITION ❑ AITEMTIC�N ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDINO RELOCATION <br />TEWWTIMPIqVE ENT071NTENtORREMODEIONLY M CONT�CiPER50NANDPNONENO. <br />1�.[. <br />� ppHT1U1CTPRICEOFWOIIM � <br />p!lGIII�F Y/0111( M10lOU�RE FOOLIOE INVOLVEC � <br />17�s�F f`T_, <br />11 n�': <br />KOCK Of <br />1 // ` " <br />I I . .., ., <br />0 <br />r <br />,�,�. � z - <br />�:t,. <br />'iii;,:i*.� .. <br />' ;r ,- <br />�:,. T <br />� -''a"' �: � ' SUB TOTAL S <br />� k�''+i1� PERM�T S <br />�'���"�'� � TOTALFEE S <br />^.FRONTB�/ REANBETBI�Ci BI�ESETI <br />� <br />� WEZONE IOT�REA V�CeNTS <br />r I O vEa <br />PEOFCAN9T. OCCUPANCYOBOUP NO.OFDY <br />ww�xv�cr _I.L Iz—� ' <br />EOfBIDd NO.OFBiORIES BSMT. OCGLOAI <br />❑Y <br />9os 2 <br />/ 1 7 HewHr u <br />EBPqINNLEPBFEWIRED O YES O <br />IGTIONAGGBY PV�N9APP0.BY <br />�J <br />I HEREBY CERTIFYTHAT I fiAVE READ AND E%AMINED TMI9 APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVIBION9 OF LAWS AND <br />ORDINANCES OOVERNINO THI9 TYPE OF WORK WILL BE COMPLETED WI7H <br />WHETHER SPECIFIED HEREIN OR NOT.THEOR�NTIN60FA PERMRDOEB NOT <br />PRESUME TO 61VE AUiHORITV TO VIOLATE OR CANCEL THE PROVI&ON8 OF <br />ANYOTHER STATE OR LOCPL LAW RE�ULATINO CON3TRUCTION OHTHE PEiM <br />FOFMANCE OF CON9TRUCTION. TH�T I AM AUTHORIZED BV THE GWNER OF <br />iHIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE BTATE CANTRACTOHS lAW 18.27 RC'W AND <br />2BB200 WAG <br />&_ONQUREOFGONTNAGTOFOR�UTMOPREDAOENT D�TE <br />7C /_ �_.� rii ��. 0/ 7. /4. �l <br />MECNANICAL <br />NO. TYPE OF EOl <br />NC—NHNDLO UNITS— <br />FORCED AIR SVSiEMS— <br />UNIT HEATERS— RT.U. <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RAN6EHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPUCE 8 CHI! <br />FIREPLACEINSERT <br />HEAT PUMP <br />OAS PIPIN� <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FEES <br />BUILDIN6 _ <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />S7ATE DUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />,: �...._. ..'..f .� ...i�::..i. -• 1:�'�^,l:,a : _ f...i.-.. . "C1 ...a s.�.. ..-. - . ., ., , ( i _ ...�., ., . J.'Ulird•Y� �.i <br />