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- -1 <br /> ' the EYHJ71Nn tiPPLICATION FO tie] <br /> CONSTRUCTIONeverett PERMIT <br /> 1 TO BE COMPLETED IN BLACK INIC-PLEASE PRINT <br /> I BUILDING DEPT. <br /> i 259-8745 0 COMBINATION ❑ BUILDING ❑ MECHANICAL 0 PLUMBING ❑ SIGN <br /> 0 NER / MAIL ADDRESS CITY ZIP PIIONE <br /> PVl y r A 116CEOR ( E7�pQR /�i-,"L1 /t. 9 f l I,'l ` l J ��3 <br /> �y�/�'() AR HITECt OR DESIGNER MAIL ADDRES§ Clly ZIP PHONE <br /> F" L <br /> �/ !41,;11I I t,lo ce- /6:7`! /' f i(t c L'il .11 r.f,lc,-,i ._FL,'3 '57 s <br /> I, ENERAL CONTRACTOR I MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> J2 1 <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY LI' PHONE LICENSE• <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> `_ CLASS OF WORK <br /> ��� t yY ` ❑ NEW ❑ ADDITION ALTERATION 0 REPAIR 0 DEMOLITION ❑ W00DSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> (/y/ V \VILUATION OF WORKICOST OF MATERIAL PLUS LABORI 1 Cye '� <br /> C ` T\ / 77 j II ? _I i / <br /> %ZITS/I C !•1'FII 'll LETS✓T'I II f- /l.vN/U ylt /{I rr,r -'/ I.' 1 [':I- `•'/T/Z /,.I .`(YI';',' 'i.'CI, ([? <br /> G ,DESK-CRIBS WORK <br /> T I/HILT ILi rE))1TI Z <br /> O <br /> +� L SE OF BUILDING r--I <br /> IC Q-t� • <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION <br /> LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE m <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br /> ��-i-n <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> ��t✓✓✓ <br /> �CyJjje✓1 OR THE PERFORMANCE OF CONSTRUCTION. .-I cn_ <br /> IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT `,Z DARE m <br /> And ! mm <br /> c-acre + IL rr <br /> -PROJECT ADDRESS APPLICANFSCITY BUSINESS LICENSE NO/t O <br /> C m' <br /> =-I <br /> m <br /> ter+ <br /> ` , PLUMBING MECHANICAL _ .O Z <br /> -� <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT _Fr-E S.-I <br /> Z/ / WATER CLOSET(TOILET) D AIR COND UNITS-H.P.EA. r= <br /> CVA/t P I 2 L1 <br /> BATHTUB _REFRIGERATION UNITS-H .EA. A Ti)I / LAVATORY(WASH BASIN) 2'00 BOILERS-II P.EA. m <br /> 70 <br /> An <br /> t SHOWER GAS FIRED AC,UNITS-TONNAGE EA _ P S. <br /> b • KITCHEN SINKS DISP. FORCED AIR SYSTEMS-B T,U Ti EA _ -i m <br /> $ DISHWASHER A2 WALL HEATERS-B.T.U. 1.1 m.-. <br /> N <br /> W LC"-r LAUNDRY TRAY UNIT HEATERS-0 T.U. M _ <br /> O <br /> CLOTHES WASHER EVAPORATIVE COOLERS _ � On m <br /> _ WATER HEATER CLOTHES DRYERS Ti'C <br /> UhgURINAL J VENTILATION FAN ---_ (SO Z n <br /> DRINKING FOUNTAIN RANGE HOOD -I• m <br /> FLOOR DRAIN AIR HANDLING UNIT- C F.M - - D <br /> �-fj�/' VACUUM BREAKERS STOVE A <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE C1111.INEY _ -I <br /> 14,1? SINK ISE RVICE-BAR,ETC.) " 2.L _,�V'OODSTOVEIFIREPLACE INSERT S.JN_ _ S_ <br /> • <br /> • <br /> J/n� SUB TOTALi'X�, __. SUS TOTAL S 3 d O <br /> �, PERMIT S PERMIT S I1I1--__ c'T <br /> TOTAL FEE S (.;:i.,'''' .u:. TOTAL FEE S -ICJn m <br /> 6. <br /> THIS PORTION TO BE COMPLLT D BY BUILDING DEPT. PERSONNEL <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAIT CHI CK NU!.IREII PLAN CHECK FEE <br /> • -- N. A TEE RECEIPT NO <br /> 40,7 <br /> USE ZONE LOT AREA <br /> '/F/�� VACANT SITE �� /� <br /> --i /I,YF. OYES EARS FEES VALUATION - FEE <br /> TYPE OOFF/CCONST OCCUPANCY GROUP NO OF DWELLING UNITS w-+-• --N R-3 / BUILDING S 7 6 S 0 <br /> 11 SIZE OF BLDG NO OF STORIES MAIL OCC LOAD <br /> 1 <br /> £' si R / N.0 R, PLUMBING -- 'W <br /> MECHANICAL od <br /> FIRE SPRINKLERS REQUIRED D YES I-NO _--—� <br /> OTHER <br /> ' PLNAT TY <br /> APPLICATION ACC BY PLANS CHECKED Dl' AI'PR FOR ISSUANCE BY --- —-- �J <br /> TOTAL b/ <br /> Le, E/t— <br />