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iu <br />(h� Evupreen <br />CITY OF <br />�verett <br />BUILDING DEPT. <br />2S�J•8745 <br />���PLICATIUtd FO ':=' <br />�UNST6�U�TiON <br />P� R li�i l lf <br />TO BE COMPLETED IN BLACK �NK - PIE�SE PR;NT <br />�COMBINATION ❑ BUILDING ❑ MECHANICAL <br />MAILAU�RF55 CItY ZIi• <br />crerelt <br />� <br />❑ PLUMBING ❑ SIGN <br />AR��Wf JSIG/ /D�/�Gi /�•L/ M�`i�wE(J � L-l��rl,C=i/ ��'/�-�. `Y�il y � i:'f:� � %/ �n•7LK�,(it1E �SJ � �Y f�� '_ <br />GFN[RALCOYtPAGTOfi 1dAILAD0�E5S Gi1Y Zi�' �'�10�1: liC[NSF.� <br />_. � <br />fAF��ANIGlC01FlRGTOR A144ADDR[SS�, Grv LP PIIONF UCE�l;E� <br />� %��-��1/7�)/�% y�% /�% ' <br />!/�U //C/I//NCj �7l� NG �pS L �`�'('Gi4f7^[a ��� �`_�r[1_j�•O �t�3f, %� <br />P}L 1MB�NGCONL{UCiJN M�ILAD�RE55 f,liY 21P PMON[ .�CI.N51:� <br />�/,l'B/�tl. yYfi �LL(/I7.�'�t,�9 e�� s� CLE�Z�/Il/�rG ll�l L G-L'C7'c t! �'r%�:�� �`_S. c,il/ h� � 6%Z �a <br />cwss oF wonrc <br />�I NEW ❑ ADDITION ❑ ALTERA710N ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSER7 ❑ BUIIDING HELOCA710N <br />VALUAiICN OF W ORK �LOST OF MATEPIALS PLUB t ABOH� <br />/�/' f`'� <br />OF PHO�'ERiY <br />';�/U(�,eE <br />;R AiT�S�W�S <br />r � <br />PFOJECiA�DRE55 <br />��� , �fl ,�� <br />� <br />I HcREBY CERT!FY THF��f I HAVE R[AD �ND EXAh11NED THIS AP- <br />PLICAiION AND KNOW THE SA�dE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF �A4VS AND ORDINANCES GOVEF;NING THIS TYPE <br />OF VJORK WILL BE COMPI.ETED WI7H WHETH[R SPEGFIED HEAE <br />IN OR'�IOT. THE GRPN'�1NG OF F+PFFMIi DOES NOT PFlESUME TO <br />GIVE AUTI{OfiITY TO VIOLATE OR CANCEL �fHE PROVISION5 OF <br />ANY GTf 1ER STATE OH LOCAL LAW REGULAI"ING CONSiRUCTION <br />OR TH[ PERFORMANCE OF CONSTRUCTION. <br />�StN. EOfCO`JIR 70HORAUiHO�IZLOAGEtlT lli.iL � <br />/ �-/S' � <br />X ;, � , � (�.� <br />�ar icnr�rscirveusn+r ;ueee�;er�o <br />FEE NO. ITPt ur tuuirmcr <br />� AIR CO4D. UNIT$-HP. EA. _ <br />��5 REFRIGERAiION UNI75-hl R EA <br />G(/ BOILERS=H.P. En -- — <br />OO GAS FIRED AC. UNITS-TUNNAGE <br />�(� FORCE� AIR SYSfEMS-B.T.U. �� <br />/�l) v.�ni i b�FATFR6-B.T.U. 'A <br />siove <br />1VOODSTOVE/FIR[PLACEINSEFlT __ _ <br />� SUB TOTAL E� _ SUB TOTAL-- S__ _�5 �v <br />TOI----7 �^{ FEHMIT _5 ____" <br />AL FEE _s I 2�C-(/ �— -__ ___TOT�L FEE___ _' g " 1� <br />THIS PORTION TO 6E COMPLETED BY BUILDING dEPT. PERSONNEL <br />FRONi$Ei9nCN RE/RSEIOACK $IDESE104CK �'LANG��CCI(NU��tlEn riatlC�'Fn�fLL <br />—__ "____.._ <br />20�7 2�F � `.�F ,�'S /6'S_�'����� y�l«��,,�:,��,�,'----- <br />USEZO� _ LOTARER WCAjii5lt[ FEES � VALUATION FCF___ J__ <br />01� <br />v- i.! <br />SIZE OF 91�G <br />iBqz S.F. <br />iCALON ACL Uv <br />� g <br />S ONO <br />IUPNNCYGFOUP NO.OF�WELLINC <br />�3 I <br />OFSTOPI[5 MR%OCC LOAp <br />2 7 <br />BY <br />rif,�r► n <br />APPF <br />euaoir:c <br />PLUti1BING — <br />!.IECNANICAI <br />OTHER <br />PENALiY <br />TOTAL <br />/I%�<</r<<<" <br />[+� <br />G <br />-1 <br />('� <br />m <br />.� .-. <br />---� T <br />r--i y <br />N 2 <br />m <br />0 <br />co <br />mo <br />� <br />-i c <br />O 3 <br />f�� <br />-i -r. <br />2 -1 <br />m <br />Q� <br />� <br />�� <br />�� <br />< <br />-„ <br />o� <br />-� L. <br />� �; <br />m� <br />N <br />� <br />or <br />nm <br />C N <br />m �' <br />z c� <br />-i r <br />. �, <br />:� <br />x <br />� <br />c <br />r <br />f" <br />