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�he t've green CC"VSTRUCTION <br /> ;irr uF <br /> evere�t PERMIT pERMIT IdO. O74ZS <br /> GITY HALL 25&87G5 <br /> eveaerT,wn 982C7 ❑ COMBINATION �I BUILDIN(3 ❑ MECHANICAL ❑ pLUMBING <br /> OWNEN � MAILADDHE55 pTY ZIP PHONE <br /> John H. Dwper 2109 Adams <br /> APCNrtECT OR DESiGNER MAIL ADDRESS crtY 2�P PHONE <br /> GENEMICANTRPt(OR MAILADDRESS CTV ZIP PHONE LICENSEI <br /> MEC'IANICNICOrvTRACTOR MAILADDPESS GITv ZIP PMpNE LICFNSFI <br /> PLUM8ING CONTRFCTOF MAIL ADDflESS CITY ZIP PHpNE LICENSE I <br /> CLPSSOF WOAK " <br /> ❑NEW XSADDITION ❑ALTERATION ❑REPAIF ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> VALUATION CF WOHY <br /> S S�rJ�O.�� <br /> DESCRIBE WORK <br /> Addition to existing residence <br /> aROPO5E0 USE OF BUILDING <br /> � sinale familv residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> iecnioescaianor�orvFOPea.v�sHowae�owoaartncrrrouacoaies� PLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT. <br /> 25-26-2a 21 Pinehurst Div. B ALL PR6VISIONS OF LAWS AND OfiDINANCES GOVERNING THIS <br /> �or �oc�oc _ TYPE OF WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO�IVE AUTHORITY TO VIOIATE OR CANCEL THE PRO� <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE O CONSTRUCTION. <br /> JOBADDRESS SIGNATURE NTR TORORRUTH EDRGENi OA1E <br /> 2109 Adams Street X �� � <br /> PLUMBING ME N1CA <br /> NO. TYPE OF FIXTUHE OR ITEM FEE N � TYPE OF EUU PMENT FEE <br /> � WATER CLOSET(TOILET) AIR COND. UNITS—H.R EA. <br /> BATHTUB REFRIGERATION UNITS—H.R EA <br /> LAVATORY(WASH BASIN) BOI_ERS—HP.EA. <br /> SHOWER - GAS FlRED A.C.UNITS—TONNAGE EA. <br /> KRCHEN SINK 8 DISP. FOPCED AIR SVSTEMS—B T.U. M EA. <br /> DISHWASHER WALL HEATERS—B T.U. M <br /> LAUNDPV TRAY UN T HEATERS—�B T U. M � <br /> CLOTHES WASHER EVAPORATIVECOOLERS <br /> WATER HEATER CUTHES DRVERS <br /> URINAL VEWTILATION FAN <br /> DRINKING FOUNTAIN PANGE HOOD <br /> FLOOR DPAIN AIR HANDLING UNIT— C.PM. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAWIEADERS METAL FlREVLACF.g CFIIMNEV <br /> S'NK(SERVICE—&4R ETCJ <br /> SUBTOTAL SUB TOTAL f <br /> GERMIT i iEPM17 <br /> . TOTAI FEE S TpTAL FEE <br /> SIDE VARD SEiBACK STREET SETBACK REAR YARD SETRACK PLAN CHECK NUMBER PL4N CHECK FEE <br /> 80/7925 FFE 1B.00 pECEiar No <br /> USE ZONE LOT AREA VACANT SITE 47894 <br /> g_Z ❑yES �10 FEES VAWATION FEE <br /> TVPE OF CONST. OCCUPANCV GROUP NO OF DWELLING�NITS <br /> V—N R-3 1 <br /> BUIIDING a 36 00 <br /> SIZE OF BLDG. NO.OF SiOqIES Mul% OCC.LOAD <br /> 16'x16' A(�C) 1 PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS <br /> 3 none �EOUIRFB. MECHANICAL <br /> :7VE5 S7fr0 <br /> AP►ROVAl.S SY p�� OrHER <br /> t ENVIPONMENTAL CMECK LIST <br /> PENALTV U.B.C. <br /> 2. BUILDING PLANS SEC.303(a� <br /> 3. FIRE NYDRANT TOTAL 36 OO <br /> <. FIRE PROiECTION SVSTEM PEIIMIT VAlID11TIpN <br /> WHEN PROFERLY VALIDATED.(IN THIS SPACE)THIS IS VOVR PERMR <br /> 5. GRAOING <br /> 6. DRAINAGE O�� ' f 0 3 6.0 0 �T � <br /> 7. ENVIRONMENTAL IMPACT STATEMENT �, <br /> B. HEALTHDISTPICI YOUR REGEIpT o <br /> APPLICATION ACC.BV PlANS CHECKED BV APPR.FOR ISSUANCE BV - <br /> v.c. <br /> TF�ANK YOU <br />