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APPLICATIOw FOR �:Q�NSTRUCT�JN PI�RMIT �� <br /> TO BE COMPLETED IN B:.ACK INK--FLEASE PRINT er��nr <br /> �_ <br /> ,_ __.._._— . . . _.._. <br /> --_ .. .-------- <br /> -- <br /> HE4TWGSVSTLM _i;.., �ELfCTRIC J ______ _ � <br /> dUILDING D[P�H17�1[NT �- — - .. _ _ --.___—_ ---- ___ <br /> 259-8870 <br /> DEMOLITION COMBINATIOIJ -}yI��—B—UILDING MEi;HANICAL PLUMBING SIGN <br /> owHln--_---'_ PnLL1ut`qk•;5"_�' " [Itv —_—_— )ir ._._--_ rv�0yr — — <br /> ji�� f��;�rr co.. �.c. �cx, ?7�� M�5 �'�=-7� 5c�r,=�- i,�� G,��z� 3yz.-s��F' <br /> � H il NANI MML ApORE55 �dT� PNONF <br /> '° � �o67NG Go . <br /> p � <i�CMI1ECT1i10E51GNER MbLADDRE55 CITY jlv PHpq[ <br /> y � N (�,V�C.G.dE.rn) P�.r,E+ll,i. ��+"'� f C' �C1� �c•'lj � S�:A-����'i? n-� l'.A. `�R2<r7 '�y.Z.—�'z� r <br /> H ffHC��iCONfP,�CiOR MULeDDRE55 CITv IiP PHONE /1 ST�TELIGENSE� <br /> y ��I(/CJi SC�1Vl'.�11..] /i'A+tf�c'Q. � C p ) �C/Ll,YLaC 9£(2Y t.Ca^i/✓P_�E/-` �(..0 �J� <br /> r< f1 � � ' CCX ."'�/�r '�� �.. a ���. <br /> � M� Q NLb�eNiC�l CONiR�CiOR MML�DDRESS GTv Ziv� PMOrIE Si1TE L�CENSE i <br /> � N N <br /> �! � � �:lnAOwGCONTMGTOA AUII ADpaE55 �rtV zIP PNONC SI�tE lIC[I�SF• <br /> ro <br /> � ^ QQQ cin;so�wonK — <br /> � �j � � NEW ADDITION A�TERATION HEPAIR DEMOLITION WOODSTOVEiFRPL INSERT BUILDING RELOCATION <br /> �~ M CONi��i o[q50N�ND PHONE NO <br /> N CtN1iR�Ct PRKE Oi WORw C�.n,v,¢ZJ _f�'STEYn BD2 S�l <br /> N <br /> DL SLfUPE YIOHn�ND 501AqE FOpUGE INVOLVED <br /> � o H 7-it ,4�Lc��- �10/ G �K -- <br /> � �� E -3s�63 <br /> nnoroSED u5E OF BUI�omG <br /> �ttl" i HEREBY CERTIfV TNAT I HAVE READ AND EXAMINED THIS <br /> N y ��=��'i L�S j P+.�_�c_ �(o- y�Z; APPLICATION AND HNOW THE SAIdE TO BE TfiUE AND CORRECT.ALL <br /> � y i(G��D[SCRioipMp�pROPER�V�SMONm BEiOW OR�Ti�CN LOUP COPiES PROVISIONS OF LAVJS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WJRK WILL BE COMPLETED WITH WHETHER SPECIFIFD HEREIN OR <br /> i�r BiaK oF NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTNORITV TO VIOLATE CR CANCEL THE ^iiOVISIGNS OF ANV <br /> _ OTHER STATL OR LOCAL LAW REGULA7ING CONSTRUCTION JR THE <br /> PERFORMANCE OF CONSTRUC110N.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> - APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 FCW AND 296 200 WAC <br /> _ � , <br /> / 7 <br /> �IIOJF.GiADDRE55 X����'"��� /. /'.7-L�«�-f�� y �}'/U �� <br /> V ORf <br /> .�3 bv. C/+s,tio 2��. '1�' - 'IL; --- -- <br /> . � Cii�P�[.�.f5$ i_�lNSe M,^. <br /> �� � � �. _ PLUMBING MECHANICAL <br /> C�' NO. TYPE OF FIXTURE OR ITEM _ FEE NO. TVPE OF EOUIPMENT FEE <br /> _ WATFR CLOSET(TOILETI A'C--A�HNOLG UNITS—HP <br /> BA7H7UB FORCED AIR SYSTFMS—B.7.U. M E.A. <br /> 1 LAVATORV(WASH BASW) UNIT HEATERS—B.T.U. M <br /> I��� _ SHOWER CLOTf{LSDRVERS <br /> ��' _ KITCHEN SINN 8 DISP VEN7ILATION FAN <br /> _ DISHWASHFR RANGEHOOD <br /> _ LAUNDRV TRAV WA7ER NEATER <br /> '�� CLOTHES WA�HER WOOD STOVE <br /> � ��� URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINNING FOUNTAIN FIREPLACE INSER7 <br /> FLOOR DRAIN HEA7 PUMP <br /> ' _ BACKFLOW PREVEN`E!i5 GA$PIPING I <br /> �I�I _ ROOF URAINS—RAINLEAD[FS E%HAUST FAN I <br /> SINN(SEFVICE—BhR,EiC.� � <br /> � �� -- <br /> � <br /> --;— <br /> � _ SUBTO7AL E SUBTOTAL $ � <br /> �I�� PERMIT S ___ PERMIT 5 <br /> �I I TOTAL FEE b 70TAL FEE 4 �— <br /> FOR OFFICE USE ONLY: <br /> FPONi5E18�CH nE�RSETBACN SIOESE1B�Cn v�ANP�ECNNUM9EH fE[ qELEiv�qp <br /> ''G -_s' <br /> usexa+e �orene� WL�NtSrtE FEES VALUATION FEE <br /> ew�oiNc, �;�� <br /> 1YM Of COMiS 1l ON.ULE TYV[Of CON9 AOWI i � rcCVNX� MO n pvtllw4 V4n5 <br /> /� ' Jy _ PLUMAING <br /> SiEOFBLDG NOOFSTOR�ES pASEMEH MECHANIC�t <br /> �, '2 �r o��0 <br /> OCNP�NCYLO�U FIRESPRNnLER511EOD NEiGNiliuiUiiON ADpIT10NALPLANCNECN �/ •J � �y�, <br /> � `� � � � �_ SPflINKLEH 1 <br /> NE�SJNFpqSPRMrcLERS __ �__ <br /> STqTE BUIL�ING SURCHARGE �/ � (�, <br /> __— —_ - <br /> iNieNE BY PUNS vPf��v[D Ev CITY OF EVERE7T PLBLIC WORK$ <br /> j '� LOCAL SALES — <br /> TAX COOE IS 3105 roTn� /O >' ;S.'S <br />