Laserfiche WebLink
i,PPLICATION FO`.-' . � ���,�n <br /> '^•""°'"" CONSTRUCTION � � <br /> rn or <br /> ev�rett PEk�V11T <br /> BUILDIN(3 DEPARTMENT TO BE COMPLETED IN INK• PLEASE PRINT <br /> 259•8810 <br /> ] DEMOLITION ❑ COMBINATION ❑ BUILDIN6 MECHANICAL ❑ PLUMBIN6 ❑SION <br /> iWNER I�MLIIDDPEl� C�tt DF FNOHE <br /> „�e-�¢ 7�J4/�i� •%cS .�71-� �Yltda � /G a[rc%T' 9�sd i d S l-'S/9 Y <br /> nCM11EC�0110ES�ONER � uML�ODPElS G fY ZIP PMONE <br /> M�II�DDRESS ��n' =�P ONONE LICENSE• <br /> :EMEML CDHIR�G1011 jT�"C/�OhDSO� <br /> �/� erJ/y c �� �B .�el./('0 �Y.�n.r.r��' 9��y� 97P-3�y _,'•i�e•o <br /> �ECH�MKeICD P tON � M�RIDDREB! CIfY Z�P PNONE IICEMSE• <br /> 'LUM/IMOCONTR�G�OA MAIIADORE!! CrtY �JP PNONE � UCENSE� <br /> �.1�]s0!W�F <br /> ❑ NEW ❑ AOGIt10N ❑ RLTEFAiION CI �7EPAIR ❑ OEMOLITION ❑ WOODSTO`/E/FRPL.INSERT ❑ 6UILDIN6 RELOCAil011 <br /> ��IWTiOlfOlY108a1CA1TOiM�IERi�IlFLUSLIIlORI ' ' � . <br /> R <br /> � 7, � <br /> iElC1UlE WOAM • <br /> .Lr-irc.0 /e� ia r rc+� f c•�af�o� J�a-.�i.ti <br /> �is[or soaoina , , I HEREBY CERTIFY 1HAT I HAVE READ AND E%AMINED THIS AP• <br /> ' PUCATION AND KNG W TH E SAME TO BE TRUE AND CORRECT.ALl <br /> �EO�lDE7GRi���ONO�PP ENIYISNO�� � E OWOR/iTAGNIOURCOPIEfi pROVI510NSOFLAWSANDORDINANCE500VERNIN6TH19TYPE � <br /> OF WORKWILIBECOMPLETED WITH WHETHERSPECIFIEDHERE• <br /> �°�—��«�—�F GI ERAUTHOR TYTO\IOLA�E OR CANICE�THE PRUV SSONS OF <br /> ANY OTHER STATE OR IOCAL LAW REGULATINO CONSTRUCTION <br /> OH THE PERFORMANC'E OF CONSTRUCTICN. . <br /> SIONATURE OF CJNiRApTOR DR�UtNOR12E0�OENT U�IE <br /> / <br /> X ,�d�� l/ �'y�� <br /> "110JECf 1100PE6S �PPUC�NTS CiIY BUSINESS LICENSE NO <br /> a� <br /> PLUMSIN6 MECHAHICAL <br /> NO. TtP!OF FI%TURE OR ITEM FEE NO. T'PE OF EOUIPMENT FEE <br /> WIITER CLOSET�TOILET� A/C—NNNDLO liN1T8—H.P. <br /> 6ATHTUB REFRIGEMt10N UNITS—N.P.EA. <br /> UVIITORY�WASH BAS�N� BOILERS—B.T.U.M.P. <br /> SHO`MER 6AS fIRED 11.G UNITS—B.T.U. <br /> RITCHEN SINK L DISP. FORCEO�IR SYSTEMS—B.T.U. M EA. <br /> DISHWIISMER WALLHEATERS—B.T.U. M <br /> UUNURYTRIIY UNITMEATEHS—B.T.U. M <br /> CLOTNES W�SHER EVAPOAATIVE COOLERS <br /> URINAI CLOTNESDRYEPS <br /> p{IIHRIN6 FOUNTAIN VENTIUTION FJ1N <br /> F�OOR ONAIN ' PIINOE HO00 <br /> BACKFLOWPNEVENTERS WATERHEATER � <br /> ROOFUR�INS—A�INLEADERS � WOODSTOVE <br /> SINK ISERYICE—BAP.ETC.) METAI FIREPIACE a CHIMNEY <br /> FIREPUCE INSERT <br /> NEATPUMP <br /> OAS PIPINO <br /> i . E7cHl1USTfAN . <br /> fUSTOTAI ! {USTOTAL � �� <br /> . OERMIt f PLIIMIT � <br /> TOTALFE! f TOTALFEE � <br /> �AONftElB�CIt AEIINSEI9�CN SIDESETD�GN <br /> p1,AN CMECN NUMBER � � fEE AECEIPT NO. <br /> USE IONE LOf�RE�. y�p�pi SRE FEE4 VALUATION FEE <br /> OYES ONO S <br /> BUILOIN6 <br /> �TPEOFpOXlt. OCLUVI.NCY6NWP NO.OFOWELLINOW:ITS <br /> � '- PLUMBING _. <br /> Si2EOfBtD1 NO.OiSfORIE9 M�cOCC.�o�o �,�ECMANICAL � <br /> .. . � � .. � �. � . . � <br /> . . . . , OTHER <br /> FIRE SPRINKLEr7S REOUIRED O YES O NO 57ATE BIIlDIN4 SUACHAROE <br /> SThTEENENOYSUPCHAR6E <br /> �OP�i��110N 1GC Bv PLAH4 CIIEGI(ED BY �PFP.FOM ISSU�NCE BY pUI1LIC WORK9 <br /> I�A N� , . . 70TAL <br /> ���� �� <br /> PROPERTV OWNERS ARE RE9PONSIBLE FOft�EiERMININO ALL <br /> PPOPERTY LINE LOCATIONS AND RELAIED F.ASEMENTS. <br />