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APPLI�;ATION FORJ `." <br />��.E"�'M� CONSTRUCTION <br />Gtt O� <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-88t0 TO 8E COMPLETEU IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATICN � BU{LDING ❑ MECHANICAL ❑ pLUM81NG <br />JWRER � _ �AML�ODNE53 Ci1Y me ......... <br />ererell <br />e <br />❑ SIGN <br />ocncnµconiv��rVx M�II.�OORECS Clrv 21P PIiON[ UCEHSE• <br />���--, /�0/ k! %�te`,t.�a.e+, �t 93(19 �X3•Bi4'b DS4�uzz.NTK j <br />EG N L�L CONiq LfOq M� L �(1DRE55 CIiY ZIP PllpryE UCENSt • <br />P/UbB1119GONfR!CfOR M�ILApDAE59 CIIY ZIP PIIONE UC(NSE• <br />GL�SS OF WOAN - <br />� NEW ❑ ADDITION ❑ ALTEHATION ❑ qEPAIR ❑ OEMOLITION .❑ WOODSTOVE/FRPL.INSERT ❑ BU:IDING RELOLATION <br />�{�LU�T�ONOfWpRK�LO510fMetERUL5Pl�5L�BOR1 � <br />—�111-o�a�' 2���� <br />� <br />ee�ow <br />PROJECI�UUAESS <br />90 z �/. (�,e-n-e <br />r�uMsiNa <br />NO. TI�pE OF FIXTURE <br />W�TER CLOSET �TOILET� <br />BATNTUB <br />UVATORV (WASN BIISINI <br />KITCHEN SINK f DISP. <br />OISH4V�SNER <br />UUNDPV TRAV <br />CIOTHES WASHER <br />URINAL <br />DRINKINp fOUNTAIN <br />FLOOR ORAIN ' <br />MCKP�pW pqEVENTERS <br />ROOf �R�INS — RAINLEA <br />SINK (SERVICE — BAR, ET <br />fUSTOTAL <br />►EIIMR <br />TOTALfEE <br />�ROM SEiB�CN tlCAq5E1B�G8 <br />� <br />usEzqyE � ior�ne� <br />� <br />L�' <br />n'PE Of �OMSi. p�pUPANCYGPO <br />Y•N - Z <br />S�2E OF BlDO pn �x smmw <br />�� <br />� <br />Y CMLGNED BY <br />�W <br />FEE <br />SIOE SEtO�`N <br />VAC�VT SiTL <br />ores �mo <br />�o. nr owEw�w <br />P0. FOR ISSUANCE <br />� <br />�� <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORREC�f_ A�� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE <br />OF WORK WI�L BE COMPLETED WITH WHETHER SPECIf1ED HEHE• <br />IN OR NOT. THE GRANTING OF A PERMITDOES NGT PRESUME TO <br />Gib'E AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />5�6k�TUREOFCONTR�L70POBAUTHORIZEUACENi DRTE <br />X �-�P a ��..�-�, r�/gg <br />PPLIC�NiS CIiY BUSINE SS UCENSE NO <br />MECHANICAL <br />PLAN <br />n/G — �/HNDl6 UNITS -- MP. <br />NEFRIGERATION UNITS — H V I <br />BO�LERS — B.T.0 /H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCED 111R SYSTEMS — B.T.U. <br />cna—a.�.u. <br />UNIT HEATERS — B.T.U. <br />EVAFOR�TIVE COOLEFS <br />CLOTHES DRYERS <br />' INTILATION FAN <br />Ratd.F wODO <br />WATEq�dP:cP <br />WOODSTOVE <br />METAL FIRtPUCE 8 CHIMNEY <br />FINEPLACEINSERT <br />MEATPUMP <br />GAS PIP�NO <br />E%HAUSTFAN <br />E:// TOTAL <br />M EA. <br />M <br />M <br />NUMBER FEE � I pE � ���,I � <br />��y � <br />'EES VALUATION f�E <br />BUILOING I $ .�BSo` <br />�I.�F/GiNG <br />MECHANICAL <br />OTMER'� �.Q-� (�f `.i—J <br />STATE BUIIDING SUHCMARGE <br />STATE ENERGY SURCHAfiGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMININ6 ALL <br />PROPERN LINE IOCATIONSAND RELATED EASEMENTS <br />r� <br />