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� :7: <br />� <br />APPLICATIC''1 FOR CONSTRU�T'�N PERMIT ��� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT • <br />BUILDING DEPARTMENT HEATING SYSTEM: k(GAS U ELECTRIC G_ <br />259-8810 <br />IJ DEMOUTION I I COMBINATION <br />11RCMITEC7 ON 1 E SI6NkH <br />������ <br />6ENF WL CONiR�CfON <br />Mec�N�cu c or�reucn <br />.���. <br />PIUMBINO Ldii��CT[»i <br />CONTHACT PPICE M �VORN <br />�� <br />]ESCNI9E W011k /�NO Shc�l <br />PP(WOBED USE OF <br />u.w <br />MMl <br />I100Rf SS <br />� <br />�fARE55 <br />BUILDING <br />C11Y <br />- �i � <br />�,,, <br />� <br />�CIIY <br />�ic.t.7 y 1 <br />CrtY <br />GIIY <br />lE WL DE9CNIPTqN Oi P110PEHTV �SNOWN BELOW 011 �iTAGN iW0 Ll7PItS� <br />LOT� IIIOCM Oi N� ���'� ��� <br />P�RCELTIUII.D NUMBER�/ 1!^ Dt%O�O�� <br />��! _' <br />LONSTRUC7NN1lO�N If.NOEH. AWf1E85. TElEP110NE HlM10FN <br />�I <br />WATER CU <br />BATHTUB <br />LAVATORV <br />6 OISP <br />CLOI"HES WASHEfl <br />UHINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />pOOF <br />FOR OFFICE U---SE- ���O---N���LY: <br />FRdiT6E1Bl�CM. � I nC�RI <br />Ji7 I <br />f�PE'U[I %OMSI ~— <br />_'.3..':.\/ ._ <br />e�r •'x y�k..u. � <br />O Z S `_iL� <br />OCCUP�NLY40hl� <br />WiANE <br />PERMIT <br />TOTALF <br />FIRE BPRINIllER4 REO'D <br />FlRF 11E09 <br />A/ O <br />qQ MECHANICAL <br />Ilv VNONE <br />:�!t_'_��o...� <br />�,�• ,•,�, <br />,,,. <br />I <br />� z��� <br />im <br />fq1T�C7 PEHSON AND P1qNf NO <br />�k'PLUMBING I I SIGN <br />9�yo 33�11s`�3 <br />74 `"lGOV <br />y�qryF "�IAI[LICENSE� <br />�� <br />PIIONk STRF LICENSE / <br />s�� _ <br />PNbNE �GfEIICENSC� <br />)iA .�. � 4_ n7 � Fia <br />� HEREBV CERTIFY THAT 1 HAVE READ AND E%AMINED TIiIS <br />APPLICATION AND KNOW THE SAME TO BF TFUF AND CORRECT. AI.L <br />PROVISIONS OF LAY�S AND ORDINANCES OOVERNING THIS TVPE OF <br />WORH WIIL BE COMPLEIED WITH WHf:THER SPECIFIEf� NEREI'n OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO O�VE <br />AUTHOR�TY TO VIOLATE OR CA"ICEL THE PROVISIONS OF AiVV <br />UIHcH SlATE OR LOCAL LAW FEGU4ATIIJG CONSTHUCTION Ofl TI'E <br />PEfiFORMANCE OF CONSTRUCTION. THAT I AM AUTHOqIZED BY THC <br />OWNER OF THIS PROPERTY 10 PEHFORM THE WOFK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STAI"E <br />CO CT R LAW1,8 W A D 296�. 0W�4C. <br />��j� !//T/ . �'1 ././L/(, <br />i�'��_��� <br />,x 141d� MIE <br />IIIYIIIItiNf4YIM.1N'A H� <br />FORCED AIR SVSTI <br />UNIT 4E�1T�R6-�B, <br />Cl �1HES DRVE:iS <br />VENTILATION FAN <br />RANGF HOIiL <br />WATEF HE.\TER <br />METAL FIREPL <br />FIREPLACE IN: <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />81GE8EiB�C1t , PIAM^•NECICNUMBER iF'F <br />C� <br />V�CANI SITE FEES <br />Il YES I I NO ;����`D�� <br />ISLINMIFI MOpIM111N11�i.bip ---- ---- <br />'j'� PU�MBING <br />B�SEMENI MECHANICAI <br />f I vEs W�10 � <br />M�w„�uMiTMl�l, ALDiAONALPIANCHECK <br />/7Q <br />��0 OTHER <br />T.U. M E.A. <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 �_ <br />nccem r«, <br />jD �/�s� <br />VALUATION _ FE �_ <br />%i� � )7� �t !� L <br />t ��r. v <br />` i Vv <br />i% ,LJ � <br />i <br />� ;,/ " <br />// ) i /1/` <br />STATE BUILDIN6 SURCMAROF. � � '� � J <br />vuru�pv.rpveoer �-OF EVEflETT PueucwoAKs �" ' � � '� ' <br />\J �Cf I.00AI SALES <br />a,rF 8��� �3 TAIf CODE IS 3103 tor�� ` <br />���� <br />