Laserfiche WebLink
rn. e..rpn.n <br />cin or <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />-� PPLICATION FO� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />���Q�O�� <br />APR - 81996 "n <br />_ . ............. e <br />CITY OF EVERE7l' <br />Public Wo�ks Dept, <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING �f MECHANICAL O PLUMBING ❑ SIGN <br />OwNER MAIL�DORE55 CiTY ZIP PrONE <br />OR <br />M�IL <br />3� � ' �;O � L / <br />PNONE LICENSE • <br />•�3�•46� r3�i�,�,a <br />PIIONE UCENSF • <br />iO{ WONk <br />NEW ❑ ADDITION ❑ ALTERA7ION ❑ qEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL,INSERT ❑ BUILDING RELOCATION <br />DESCpiBC WOPfl <br />BUIL�ING <br />� av <br />PIUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET �TOILET� <br />BATHTUB <br />LAVATORY�WASHBASIN� <br />SNOWER <br />KITCMEN SINK 8 DISP. <br />DISHWASMEF <br />LAUNDRVTPAV <br />CLOTNES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOH ORAIN <br />BACKFLOW PREVENTEHS <br />ROOF DRAINS — RAINIEADERS <br />SINK �SERVICE — BAR. ETC.) <br />or <br />Sll! TOTAL <br />PENMIT <br />TOT��FEE <br />or <br />4vvLICAiIONACC.6Y �PLnNSCMfL� 9Y <br />0 <br />SIDE SETB�CK <br />V�C�NT SIiE <br />OVES oN0 <br />NO OF D W ELLING U� <br />MP%. ppC. IOAD <br />APPq.FOPI55UANCE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORqECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL t3E COMPLETED WITH WHETHEH SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AU7HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUREOFCONiRqCTORORAU�ORI2EDRGENT pRTE <br />MECMANICAL <br />A/C — AMNDLG UNITS — M.P. <br />REFRIGERATION UNITS — M.P. <br />001LER5 — B.T.U.M.P. <br />GAS FIRED A�C. UNITS — B.T.0 <br />� FORCED �IR SYSTENS — B.T.� <br />WALL NEATERS — B.T.U. <br />UNIT MEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />'CIOTHESDRYERS <br />•VENTILATION FAN . <br />RANGEHO00 <br />WATERMEATER <br />WOODSTOVE <br />METAL FIFEPLACE d CHIMNEY <br />FIREPLACEINSERT <br />MEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAI <br />PCIIMIT <br />TOTALFEE <br />P�AN CME�K NUMBER / I FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCH.>PGE <br />STATEENERGVSURCHARGE <br />PUB�IC WORKS <br />TOTAL <br />M EA. <br />M <br />M <br />RECEIPT NO. <br />FEE <br />PROPERTY OWN[RS ARE pESPON518LE FOR DETERMINING ALL <br />PROPERTVLINELOCATIONSANDRELATEOEASEMENTS. <br />