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�''- <br />�APPLiCAi'I� f� FC�-�� <br />'".`"'°`"° CCI�NSTRlICT10N <br />aTr or <br />ev�rett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINA � ION ❑ BUILDING <br />��� �R£u 5 M,l ��/SD - d o 5 T <br />�OfM�mf.�OYOF'lIONEH AUIL�DDPE99 <br />MECHANICAL O PLUMBIN3 ❑ SIGN <br />;c/�' Z,P a �.�- 3 S�S�''v <br />OENER�LGG��fRA;IOR M�ILApDPE55 CrtV ZIP vNCNE 1,ipEHSE• <br />❑ ��EW ❑ A�DI71Gt! <br />�� /�s'a%v �a�/-- �� Av x��: �� ��3s- �osy� <br />MML�OOnE53 CIrv���I�p'„ _ / PNONE �� LICENSE• <br />r(J-fc 3 � <br />LY /ALTERATION ❑ HEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDIN6 RELOCATION <br />! ' <br />°Fc.�i�°i1��Z-�-� �-�u�c� -��M o��, �a Fafl� /�C•� � <br />_ '�hC-C_ EI 5' th� <br />�r <br />�oi_ e�ac�.— <br />D - �l) � T <br />PLUMBIN6 <br />NO. Tl'PE OF FIX7l <br />WATEP CLO:ET �TOILET) <br />BATHTII7 <br />LAVATORVIWASk BASIN� <br />KITCHEN <br />UUN�RV <br />CLOTHES <br />FLO0/1 ORAIN <br />BACKFLOW PREVENiE <br />ROOF t)RAINS — RAINI <br />SINK I�ERVICE — BAR. <br />/PONISEIB�CN <br />SUOTOTAL <br />PERMIT <br />TOTAI FEE <br />RE�RSETBACN <br />FEE <br />tlNC tltltlllM <br />I HEREBY CERTSFY THAT I HAVE FEAD AND E%AMINED THIS AP• <br />PLICATIqN AND KNOW TH'c SAMc'i O BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF �AWS AND ORDINANCES 90VERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WNETHER SPECIFIED HERE• <br />IN OR NUT. THE GRANTING UF A PERMIT DUES NOT PFlESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROViS10NS OF <br />ANYOTHER STATe OR IOCAL LAW REGULATING CON5TFU�TION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />$IONAIUHE OF CONiRFCiOR OR AUiHONZ 0 AGENt ❑ATE <br />X L/.GGYco�% <br />•rvuceHrs cirr <br />DO <br />MECHANICAL <br />AIC — NHNUl6 UNITS — H.P. <br />PEFqIGERATiON I INITS — H.P. F <br />BOILERS — B.T.U./H.P. <br />GAS FIRED A.C. UNI75 — 8.T U. <br />FORCED AIR SYSTEMS — B.T.U. <br />WALLHEATEFS—B.T.U. _ <br />UNIT HEATEfi9 — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHES 011YER5 <br />VENTIIATION FAN <br />RANOEHOOD <br />WATER HEATEH <br />WOOUSTOVE <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPIACEINSERi <br />HEATPUMC <br />OAS PIPINC <br />E%HAUSTFAN _ <br />SUBTOTAL <br />pERM1T <br />TOiALFEE <br />PLANCHECKNUMBER �FEE <br />wceNr sire FEES <br />OYES ONO <br />ew�oiNc <br />NO.OF OWELLINO UNIfS <br />PLUMBING <br />Mez. occ. �o�o <br />MECHANICAL <br />OTHER <br />STA1E BUILDING SURCHARG <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />S <br />M <br />M <br />M <br />FEE <br />PECEIPT NO. <br />PROPERTY OWrlEPS ARE fiEuPONSIBLE FOR DETERMININO ALL <br />PPOPERN LINE LOCnTI0N9AND RELI.TED EASE4IENTS. <br />:lM6M"JiNACNt^.r_r,: j, a. _' ' . ;... . . . . • . • <br />�...i.i�.�:,. .�.....:. . �......�.- / iof�. 'l:"i .a .x:!_'.. . J <br />' . . . . .. . ... , . �.r1� .. / .1i�- .%i�.. 1� Y�.W_�..^.�h:•��i <br />