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dir EcerGreen <br />Ciiv Ot <br />�verett <br />CI fV HALL Y59-B:IS <br />� �on�s-r�ucT�or� <br />PERI�IIIT PERMIT NO. 1J7HO <br />EVERF77,y�q9B201 � COMBINATION ❑ BUILDIM1G c�it MECHANICAL ❑ PLUMBING <br />OWNER MAIL RO�PE55 GIiY lIP PHONE <br />ROBERTA MASO21 PO BOX 2465 FVFurmm wa aa7na 355-aQ09 <br />APCHREGT OR DLSIGNER MRIL ADO��ESS C�TV JP PMONE <br />�ENEPAL CONTRACiOR MAIL A�DRE55 GiTY ZiP PMONE LILENSE � <br />Same _ <br />MECHRNIGL CONtPAGtOR MAI� ADORE55 CITY ZIP PNONE UCENSE � <br />PWMBING CONTRACTOR MAIL ADOPE55 GtY DV PMONE IICENSE I <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN �( WOOD STOVFJFIREPLACE INSERT <br />s <br />�ESCRIBE WORK <br />LOT _ BIOCK _OF <br />Beverly Blvd <br />PLUMBINO <br />TYPE OF FIXTURE OH ITEM <br />BATMTUB <br />LAVATORY(WASH BASIN� <br />SMGWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />L/.UNDRY TRAY <br />CLOTHES WASHER <br />WATER MEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF ORAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />PE� .11T <br />TOTAL FEE <br />STREET SETBACK <br />SIZE <br />/. ENVIRONMENTAL CHECK LISi <br />F. PUILOING PLANS <br />3. FIFE MVDRANT <br />4. FIRE PRO.'ECTION SYSTEM <br />S.GRA�fi1G <br />6. ORAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B.HEALTM DISTRICT <br />FEE <br />f <br />s� � <br />REAR VARD SETBACK <br />VES NO <br />FORISSUANCE BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AN�I ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECiFIED HEREIN UR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESU� TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PRUVISIUNS OF AN� OTHER STPTC OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUGfION. <br />SIGNATURE C�ONyTFt�A,GIOR OR ROTMCRIZED AGENT �ATE <br />X �/ij'cGc�+.B�Z/ 12/6/85 <br />MECHANICAL <br />N0. TYPE OF EOUIPMENT FEE <br />AIR CON�. UNITS — H.P. EA. <br />REFRIGEPATION UNITS — H.P. EA. <br />BOILEFS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.TL. M EA. <br />WALL HEAiERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRVEHS <br />VENTILATION FAN <br />HANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />ME1AL FIREPLACE 8 CMIMNEY <br />FIREF�ACE INSERT <br />MEAT Pl1MP <br />SUBTOTAL f <br />PEflfAIT S _Y� <br />TOTAL FEE f � <br />PLAN CHECK FEE <br />FEE I RECEIPT NO. <br />FEES � VALUATION � FEE <br />BUILDING I S <br />PLUMBING <br />MECMAN'CAL <br />OTHER <br />PENALTV U B.0 <br />SEC. 30J <br />TOTAL I I % I SO <br />PEHMIT VALIOATION '{., C�p� � <br />WHEN PROPERLY VALIDATED �IN THIS�SPA�P�' THIS R��',PpRJrENMI� � ''� � <br />; z-, <br />r- <br />IV'� <br />< � <br />ADDRESS FILE <br />Z <br />O <br />-� <br />n <br />m <br />... ... <br />-i � <br />�, -i <br />N 2 <br />v <br />m <br />co <br />mo <br />n <br />om <br />s� <br />m <br />o i <br />C <br />r 2 <br />1 N <br />� <br />� <br />O A <br />�1 Y <br />-i m <br />S <br />m �-. <br />N <br />O <br />or <br />� m <br />C N <br />3 tn <br />m <br />Z (l <br />-� r <br />. m <br />A <br />A <br />1 <br />2 <br />a <br />2 <br />� <br />2 <br />N <br />Z <br />O <br />1 <br />C'f <br />m <br />