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APPLIC�.fION FOR CONSTRI.�.'TION <br /> PERMIT <br /> tha b'c�nmen ��P1�1O�� <br /> CITV OF � <br /> ev�rett <br /> BUILDING DEPARTMENT <br /> 259-88�0 TO BE COMPLETED IN INK- PLEASE PRINT <br /> cnrver� r:<i�ncrr:i�. <br /> o,. ziv �..or.�. <br /> f��i n� � 1�� s�L.� d=�n��,� Q�dy, ���A.1 f�::,e� 7T �.�ao s �,��0��3 v�9 a y�/ — <br /> i(r:nra ianrtnem+css 7 cirr <br /> cnCnilCGiOq0E51GNCR MULA0DFE55 CIIT ZIP PHD4E � <br /> GV.fn4CONiRAC10P/^ idslLAppR[55 f �/ CIIY 21P pr PIIONE LIGEN[C• <br /> low5'Ir y�S SD . �t..'/S S/ /7o�.'QdC CVA3�__lOol��.� '7�I�I'Y.�.�I' Iy70/� <br /> H (] H iC M c.. _-- <br /> MPIIAp�R[55 CrtY ��{` i'1'ONE I�GENSI• <br /> � �� IdCOUNIPLLONiR/.CiOF . <br /> a H - Cily 2iP �MONE UCENst. <br /> A ��' VWMDINGCONTPALiOR M�qAppIiL55 <br /> � H <br /> � x �' __ __ <br /> H 9 � <br /> ��aS'S0f WOPx <br /> H x H ❑ qE1V ❑ AO�ITION ❑ A�TERAiION ❑ RePAIR ❑ DEMOLITION ❑ \VOODSTOVE/FRPL INSERT ❑ BUILOING RELOCATION _ _ <br /> K n GONi4CTPER50N4NDPNONENO <br /> F�]�j i[NnNilAIpPOVEMENLOFIN�ERIORFEMOD[LONLV � <br /> hC H � L��+iP�CiFNiLEOFN'ORK � l - <br /> y H pG cCRI�[WOPK AN�SOU�FE FOOiAGE 1NVOLVEO <br /> �o� ayxat� ;9��d,_ _ -- - <br /> yd i-uoroSEousEOFBu•��ortu6 � IMEP[BYCERTIFYTMATIHAVEREADANDEXAMINEDTHISAPPLICATION4ND <br /> OH <br /> C�rAAA C KN0IVTMESAMETOBETHUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> � n (y ORDINaNCES GOVERNING THIS NPE OF WOfiK WiLL BE GOMPLETED WITH <br /> ri t� o �[a>�n[scairuono PFOPERiYISHpNNBELOWOP1Ti/�CNfO11RCOVIE51 y�HETHERSPECIFlEDMEREINORNOITHEGRANTINGOFAPERh11TDOE5N01 <br /> �� p PRESUb1LTOGNEAUTNORITYTOVIOLATEORCANCELTHLPROVI510NSOF <br /> ~ �ot_�7 eioCrc di ANVOTMERSiATEORLOCALIAYJFEGULPTINGCONSTi:UCTiONORTHEPFR� <br /> Z y � ,l FORh1ANCE OF CONSTRUCTION.THAi I AM AUTNOPIZE�BY THE OWNER OF <br /> � z I�Io�p � � � 'r � �!/ THISPFJPERNTOPERFOiiMTHEWORKFORW�ICM�P�UCAT10YISh1ADE <br /> H y � / 'V� R���`� ��t � t � ��— AND I COMPLV WI7H THE STATE CONTRAGTORS L��:: 1P2� RQ'J FND <br /> ��y I ) ( �/ (- ) 296200 W�1C. <br /> �� �0����i'Ly' PLJ�S '��ia. �cel� /��� e.JFAt7LINi sr.�:<iuivEocov�acc�o�.rn.<wno�armnc[v� ona <br /> �'i�� I.�f�• aa9�„f��1— l��s �L. ,/zLy/G'f- �(��ad __ X � � 'C�' ���c-4. - - —� —c/—j <br /> 1-�- : 1 -, . <br /> Z H V� rnaicc*nooaess ,J/ /^� 1 f5i=4•. <�iraus:vc�=uru,scnonr�oousn�cssN>�•� � <br /> H O V1 PC�O� C ���i.'�l �1" W%A^ <br /> �?�` v <br /> i�� cCHANICAL <br /> PIUMBING <br /> �� NO. TYPE OF FIXTUAE OR ITEM FEE .-O. TYPE OF EOIIIPMENT FEE <br /> WATERCLOSETITOI�E� AiC—A/HNOLGUN1IS—HP. _ _ . _ __. <br /> 1 — - FORCED AIR SVSTEM175—B.TL. ��EA _ . _ <br /> BATHiUB - -- - -- — <br /> � ._� IAVATORY�WASHBASIN) _ _ UNITHEATERS—BT.0 M =_ ___ <br /> ��1 SHOIYER CLOTNES ORVER$ <br /> KITCMEN SINKB�ISR _ VENTILATION FAN — <br /> DISHWASNER RAN�EHOOD _ _ <br /> ' �� LAUN�RVTRAY WATERHEATER <br /> ' 1 CLOTMESWASHER WOODSiOVE — <br /> I� UFiINAL METAL FIREPLACE 8 CMIMNEV _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> ' � pi nOR DRAIN HEAT oUMP — <br /> I �� 1 BACY.FLOW PREVENTER$ GAS PIPINCa <br /> � qpOF DRAINS—RAINLEADERS E%NAUST FAN -- <br /> SINK�SERVICE—BAR.ETC) _ — — — <br /> �1 � <br /> � <br /> SU9TOTAL S <br /> �-� PERMOTAL 5 — FERNIT 5 _ _ <br /> � TOTAL FEE S TOTAL FLE 5 <br /> inONiSBBACK PEPPSflWCR 90ESEIDACN PIANCN CMNIIMBEfl FEE f1ECE1PTN�. � ^ <br /> Zb' _ �y� � . ��� :,��� ��� ��' �C'�� � <br /> �-- <br /> ��..i,oN� �ornaen �>cA�rtsrte. FEES VAIUATION FEE <br /> � _ I ]YES ,�NO � (�, <br /> BUILDING �ry���U __ ___ f G��_. <br /> nr[OFGONSi OGLUPANCVGPOIIP NOOFCWEIUNGUNItS ---- --� <br /> ei�.�;:noicAy*y<y" � PLUMBING <br /> �'/./ .__ _ _ _-- —___'_ __' <br /> 5¢EUioLOG.- Noo�'Sioaie5 Bsrni OCGLo�D MECHANICaL <br /> . S / S� � Y r�[icHtuM H OTNER '�U u��N �� J '� _. <br /> / <br /> iIRESFRwnLEP5P;0VinE0 ❑YES ' /� STATEBUIIDIN�SURCMARGE _ 3 �L_ <br /> STATEHNERGYSURCHARGE _ _ <br /> APPUUiIpNPCCBT PUNSAVPROY PUBLICWOFKS <br /> '_ � <br /> �r`�� 1�/ I <br /> �- - ,_„y�J TCfAL I ' �� <br />