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��.� z� <br />, � : PLICATION F NR� . , <br />fMEwqrMn. � � :::e p.;�..-. .�. :,,,:�.��:CON�STRUCTIO � <br />�„ o� <br />�eVerett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK • PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING _O MECHANICAL <br />q <br />O PLUMBING <br />❑ SIGN <br />��n. t�p OHONE L�GENSE • <br />OENER�IGONiF�GTOR MAIL�UOAE55 � . <br />fiQ�� �r Cltt LIP PNONE 4CEHSE • <br />MEGH�NIULGONTR�CTOq M�ILAODRE55 <br />PLUMBINdCONIR�LTOR , <br />M�IL�DORESS GITY 21P �'��ONE LIGENSE• <br />❑ NEW ❑ ADDITION � <br />�V�LWTIONOF WORNIC0910f M�i[/P/I <br />f ' <br />DESCRIBE W �(/ <br />x � C// %O! 1+-� � <br />use or ew�oiea <br />� �'�1ub <br />LEOAL OESCp�PT�ON OF PqOPEPTYI9M <br />ALTERATION ❑ AEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />0 <br />v� <br />OR <br />PROJECT�DDRESS , <br />� .�4l3 u��' �-1 �T' � <br />� PLUMBING <br />NO. TYPH OF FIXTURE OR ITEM <br />W�TER CLOSET �TOILET� <br />BATHNB <br />LAVATORV IN'�SH BASIN� <br />SHOWER <br />rirewCr� SINK S OISP. <br />URINAI <br />ORINNII <br />FLOON <br />BACKFI <br />ROOFC <br />FRONT: <br />TYFE OF CONST <br />� <br />SREOFBlOa � <br />f' <br />— 9AR`EfC ) <br />SUSTOTAL <br />pERMIT <br />TOTAL FEE <br />NE�R SETBACK <br />/ � <br />LOT�pEA <br />OGCUPANGYGFOUP <br />f� —Z <br />NO.OF STORIES <br />Bv <br />PlRNSI:MELNED BY <br />' O"�-/ <br />PLICAT ON AND KNOW THE SAME TO BETRUEANDCOHRECT. ALL <br />PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE � <br />OF WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRtSUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGN�TURE OF CONTRRCTOp OR AUTMOR12EU FGENT OATE <br />X . L�n , �o � .�e rr D„ � /.2—d'�' <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />p�C — A/HNDL6 UNITS — M.P. <br />REFPIGERATION UNITS — H.P. EA. <br />BOIlERS — B.T.U.iN.P. <br />OAS FIRED A.C. UNITS — B,T.U. <br />FORCED AiA SYSTEMS — e.T.U. M FA <br />WALLNEATEPS—B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPONATIVE COOlERS <br />CIOTMESDRVERS <br />VENTILATION FAN <br />qANGEHOOD <br />WATERHEATER <br />WOODSTOVE <br />METAL FIREPIACE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPINO <br />VAC�NT S�TE <br />OVES <br />NOO DWF.LLINGUNITS <br />OG4lOA0 <br />�� <br />FOFISSU�NGE BV <br />� <br />SUBTOTAL� <br />P[RMIT <br />TOTALFEE <br />wAn Cn CK NUMBER FEE PECEIPT NO. <br />��lav(I 3 _� l�s�- G��� <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERG�SURCHARGE <br />PU9LIC WOFKS <br />TOTAL <br />ppOPERNL�INELOCATONSANDN ELATEDE SEMENTISINGALL <br />� ._. ..—.._......_.,-. � . . . .r � ,.. c�', . _. ... . <br />. . . . ..� �—� <br />..�.....,., ._._��.., ..__.. " -.�o•...--.. . : <br />