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� '"` pLICATION FO "T <br />�����n <br />I �ME».�...° ..CONSTRUCTION O. <br />I un or <br />everett �PERMIT <br />BUILDING DEPARTMENT r0 BE COMPLETED IN INK • PLEASE PRINT ��%a,Sa'%'r9I� <br />259•8810 <br />� ❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANIGAL ❑ FLUMBING ❑ SIGN <br />�� - M�IL�DORE55 Clrv 2i� cMONE <br />OWNER � z,�_�T u.� 4Su3 �3-5?5�19 <br />� I g. P..�`( gR�! J!� l,7 �'� �1 � LI.n� � <br />�� �qGNIfEL10RDE5i0NE M�� OORE55 <br />cnr z�� ��oN[ <br />�. <br />oparyE � UGENSE • <br />nr10NE UGENSE • <br />N' � u�i�aonn[ss cnr nr r <br />PLU V BIN . CONiR�CfO . <br />A1 rt_ <br />CLA590� WOUK <br />❑ NEW ❑ ADDITION ❑ ALTERA1iON ❑ NEPAIR ❑ DEMOLI110N ❑ WOODSTOVE/FRVL.INSERT <br />V�W�T�ONOfWDHM�GOSTO�M�IER1�L51'LOSLABONI, —' _ <br />LEO�I �ESGRiP110N O� <br />�or�. e�oc� - <br />iOJEGT�DOAES: <br />V � <br />n�.u_� <br />OR <br />U�ATORY �WASM 9�; <br />SMOWER <br />KITCHEN SINN 6 OISP. <br />pI5MWA5HEN <br />UUNDRY TRI1Y <br />CLOTHESWASMER <br />OOR D�AIn <br />1CKF�OW PNEYF.NTEFS <br />JOF DR�INS — R�INLEADERS <br />NN ISERVILE — B�0. ETC � <br />SUlTOT�L = <br />PERMIT : <br />TOTAL FEE s <br />� n RE�RSEIB�R �J�� <br />I <br />.� `0'c�.i-1ti � <br />BUILDING RF.LOCATION <br />I HEREBY CERiIFV THAT I NAVE READ AND EXAMINED THIS AP• <br />PIICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVEfiNINGTHIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO <br />GIVE AU7HOf±ITY TO VIOLATE OR CANCEL THE PROVISIORS OF <br />ANV OTHER STA7F OR LOCAL LAW REGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. ,, <br />SIGNRIUAE OI' CONIRACiO� O� AlIT110R12ED AGE T 11AiE <br />x � � � � � I1ZI$$ <br />MECNANICAL <br />FEE NO. T'PE OF EOUIPMENT <br />piC —/ iNNDIG UNIiS — M P <br />RE�AIGEP/ TION UNITS —H P EA. <br />BOILERS — B.T U iH P <br />GAS FIRED A C. UNITS — BS.U. <br />FORCED / iA SVSTEMS — B 1.U. M EA. <br />WALLHcAtERS—BT.U. M <br />IINIT MEATERS — B T U M <br />EVAPONATIVE COOLERS <br />CLOTNES �R�ERS <br />VENTILATION FAN <br />RANGEHOOO <br />W�TER MEATER <br />WOOOSTOVE <br />METAL F!^EPLACE 8 CMIMNEY <br />FIREPLACEINSERT <br />HEATPUMP <br />pA5 PIPINO <br />F%HAl15T FAN _ <br />' V�C�NT SitL <br />�YES �MO <br />iROIIP NO OF OWEllINO UNITS <br />�� y <br />.c MAN OCG LOAO <br />C <br />�FIFE SPRINKlERS REOUIREQ O �ES `r <br />•VCIICAiION <br />vL�NS CIIECN[D BY <br />�W <br />�ORISSO�NGI <br />�""� <br />SUBTOTAL <br />PLAN CHECN NUMBER FEE XECEIPT NO. <br />��/,��l9 yG� /3, <br />� <br />BUIIDING 5 O <br />PIUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SIIRCHARGE �� <br />STATEENFNGYSURCHANGE <br />PUBLIC WORKS � <br />?OTAL <br />�r <br />PROPER7Y OWNERS ARE RESPONSIBLE FOR DETERMINING ALL .: i�.r�' <br />PROPERTY LINE LOCATIONS AND RELATED EASEMEN7S. <br />,��w';,. ., . . . , . . . . . . . . � ; . . �. . . . . <br />