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„. <br />fhe EverOroen `���A P P L I C A T i O N F O� � eve�efl <br />��TM�F CONSTRUCTIOf� ,� <br />ev�rett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COM8INATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />Cil/.�EV � f S t/(.� S�' t'� ea� ���ss •"S f �-vQ� enr zir r�wrie � — <br />� � � %%� �r5.10/ .� 5 /L 5 l -S <br />enenneci on oe�iar�en � ennu aooneso em zir PuONE <br />OENEBALGONtRRJiOR MAILAOORESS CitY ZIP PIIONE IIGENSE+ <br />MECII�NICr1LCONIRI.QOq MAILAD�IIE59 CIIY ZIP 1'110N[ LICENS[• <br />GlRSS OF WORN <br />❑ NEW ❑ ADDIiION <br />vaLUA11oi1 or wOnK �Cosr or rAn <br />� � DO C> <br />nescnioe wonK <br />USE Of OUI1011lO <br />lEOAL OESGRIPiION OP <br />�oT�o�oc�_ <br />M�IL AOORE59 <br />LILENS[ � <br />ALTERATION ❑ f7EPAIR ❑ DEMOLITION ❑ WOODSTOVE/fRPL.INSERT ❑ BUILDING tiELOCATION <br />e1i o.L %ur � <br />��/V /�lL�. z `��f �r5 <br />zOJ f� `nsT p� �i✓n <br />��<r�f� Gv'�r� <br />PROJECIRpDlIESS <br />� {� <br />� Y/5” S r � �< U« <br />PLUMBING <br />NO. TYPE OF FI%TUFlE <br />kfATHiUB <br />LAVATORV�W�SfI B/ <br />SHOWER <br />KITCIIEN SINK 8 015 <br />DISHWASHER <br />LAUNDRY TMV <br />CLOiHES WASIIER <br />WATER HEAIER <br />URINAL <br />DRINKING FOUNTNP <br />FLOOf7 �RAIN <br />VACULIM BREAKERS <br />PEfIM1T <br />F � fY/S�•'li /�dJi" <br />I HL'REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLIC 4TION AND KNOW THE SAME TO BETRUE ANO CORRECT. ALL <br />PRC JISIONS OF LAWS�ND ORDINANCES GOVERFIING THIS TYPE <br />OF'NORK WILL BECOMPLETED WITH WHETFIER SP[CIFIED HERE- <br />IM OR NOT. THE GRANTING OFA PERMITUOES NOT PRESUME TO <br />(iIVE AUTHORITY TO VIOL�ITE OR C/1NCEL THE PROVISIONS OF <br />AIJY OTHER STATE OR LOCAL LAW REGUI.ATING CONSTFUCiION <br />OR THE PERF09MANCE OF CONSTRUCTION. <br />SICsNFTUFE OF CONiMCTOP OR AUTMORIZED AGENT DATE <br />X �f�'lc.. if-a- / �--/f ��S~ <br />APPU �NiSGiIV&f.r 'SSUGEN, NO. <br />iVPE OF <br />AIP SYSTEMS—B.T.U. M <br />IIEATEf7S—B.T.U. <br />8 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />iRON15EtpACK� ftl41i5EI�ACH �SIDFSF.lOA,^.K �L�C���/�EO pEE �pNfi,ECEPiNO. <br />N; <br />N.n <br />iYPE Of CONSi. OCCUPANCV GfR <br />S��E���N ��� �.�,o3s <br />y�� sF. I N� <br />l <br />VACAN! SIIE <br />❑YES 6lNO <br />A1AX.00G LO�D <br />� •�- <br />pY <br />BUILOING <br />awn�oiNc <br />IAECH�NICAL <br />OTHER <br />PEN�LTY <br />TO1AL <br />7/� � _I_ <br />FEES �/LU�TION EE <br />5 <br />