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rn. E»ro�M^ <br />��no. <br />�verett <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION ❑ <br />S=.�PPLICATION f0�.� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />C <br />evereM <br />e <br />❑ SIGN <br />•R UflCl U .�UNL�t' Mert �D��C55 �'^ •^ •••"••` <br />CFNEA�L CON114C10O M�IL �0�111CSi G��� !�P I+PONE LICENSE • <br />R'Ilar/7le k <br />_ ........o....ee Cilv iIP PHONF. LIG[N9E• <br />�►�l N1 80� <br />`QJSNEWnnr� �PDIIION ❑ �LTERATION ❑ RFPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSEFT ❑ BUILDING RELOCATION <br />v�iwnON or wonn icOsi ur s��n nut s rtus i nnqn� <br />OESLPiBk w.�nn D , / _ <br />� . i /�1R <br />Cll <br />OLUMOIN6 <br />UVATORY�WASM <br />SMOWEN <br />KITCMEN SINK 6 0 <br />DRINI(ING <br />ORIIINJ — <br />ISERVICE — <br />�PONi $EtB�CN <br />f.oviEs <br />I HEREBV CEf7TIFV THAT I HAVE READ AND E%AMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVIS�ONSOF LAWSAND ORDINANCESOOVERNINGTHISTVPE <br />OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORIdANCE OF CONSTRUCTION. . <br />SIpN�lUf1E O� GONfRACfOR OR AUTNOPIIEO �GENT DAIE <br />X �e!'l� _. ,P�� /_ �� _Q,P <br />MECHANICAL <br />OR ITEM FE! NO. TYPE OF ECUIPMENT <br />NC — 11/MNOL6 UNITS — H P <br />PEFRIGERATION UNITS — HP. EA. <br />004ER5 — B.T.0 /H P. <br />GAS FIPED A C. UNITS — B.T.U. <br />FOHCEO �Ili SVSTEMS — B T.U. M <br />WAILNEATERS—BTU. M <br />UNITNEATERS—BTU. M <br />EVAPOP�TIVE COOLERS <br />� CLOTHESORYERS <br />VENTIIATIDN FAN <br />RANOEHOOD <br />W�TER HEATER <br />15 WOODSTOVE <br />METAL FIREPUCE 8 CHIMNEY <br />FIREPUCE INSERT <br />NEATPUMP <br />OAS PIPINO <br />HUSTOTAL <br />PERMIT <br />TOTAI FEE <br />R SF.IB�CN <br />USEIONE LOIAPE• <br />rvPE O� [OY51 OCCUMNCY GROOP <br />Si1E O� BLD(i HO Of S�UniES <br />FIRE SPRINKLERS AEOUIRED U YES ❑ <br />•vni¢<noH.cr, m vur�sc�¢cneoer <br />� <br />WC�Hi 511[ <br />OYES ONO <br />NG OFOWtLLINO <br />M�% OCC LOPO <br />ov <br />FEE <br />SUS TOTAL <br />P[RMIT <br />�— TOTIIL FEf � <br />PLAN CHECK NUMBGR � FEE I RECEIPT NO. <br />0'JILDING 5 <br />PLUMBING <br />MECHANICAL � <br />OTHER <br />STATE BUILDING SURCMARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORNS <br />TOTAL _� <br />PROPERTV OWNERS ARE RESFJNSIBLE FOR DETERMININO ALL <br />PROPERTY LINE LOCATIONS AND RELAiED EASEMENTS. <br />