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, %PPLICATION FO.� eYeTBN <br />the <br />°"" CIFYOFCONSTRUCTION <br />an of <br />evereLL PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />E <br />GENE RALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />A—yro1 L <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE - <br />M. NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />USE OF BUILDING <br />DAt",a pp <br />L<j'r I/-t - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE F CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEa ESCRIPTIONOfPROPERi ISHOWNBEIOWORATTAGIIFOURCOPIF51 <br />LOT- BLOCK OF <br />PROJECT ADDRESS <br />31 S-i- <br />PLUMBING <br />APPIICAN CRY BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />_ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND, UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY IWASH BASIN( <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP, <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE CHIMNEY <br />_ <br />SINK (SERVICE -BAR, ETC.I <br />{n <br />WOODSTOVE/FIREPLACE INSERT <br />515 <br />SUBTOTAL <br />PERMIT S <br />_ <br />SUBTOTAL <br />PERMIT IT <br />1 SLJV <br />TOTAL FEE It <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />NEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />nECEIPT NO <br />USEZONE <br />LOTARLA <br />VACANT SITE <br />OYES ONO <br />FEES <br />YAT.UATION <br />FEE <br />TYPE OF CO -AST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCO. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />qq <br />c-, <br />C <br />OTHER <br />PENALTY <br />PPLICATIONN ACC `/ BY <br />APPLICATION, <br />V A <br />1•I .UI SCHECKIDBY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />^ l <br />