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'""""'"" CONSTRUCTION <br />crtr oF <br />everf;tt wERMIT <br />BUILDING DI=PARTMENT <br />259•8870 TO BE COMPLE7ED IN INK - PLEASE PRINT <br />O OEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />_ Diti�A• 1'�iq � �,f�' <br />i <br />v <br />❑ PLUMBING <br />'d'� �F3 �3c93o <br />everetl <br />� <br />� <br />PNONE LICENSE • <br />�'vSywvi?� �STi�. /�/o/C�'. �liy��sa.� �-'-�art� ��L%'% 2B3 iijSlv 0`X/!1/1�i�r�� <br />'nLC���Ni,^.�LCONiR�CTOq M�ILADDRE55 CItY ZIF PIIONE IILENSE• �� <br />�'LUM9INGCON�NA�ION MM��DOBE55 �IIY j�p <br />PNONE IICENSE • <br />�Y�5501 WORY. Ty � - <br />❑ NEW ❑ ADDITION Y�`ALTERATION ❑ HEPAIR ❑ UEMOLITIQN ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDIN.�', REIOCAIION <br />/�l W��ON OF WOpN �CO51 O� MAIf RIp�S PWS L�OORI <br />2B ,vo v <br />ttl S�Cfi�L UN/��n — I <br />i OI_ BIOCk_ OF <br />/�7iR-G /t�� <br />�� Z �/oRr/� � <br />�'�OJELI�ODRE55 L'�C� /+�r"l� <br />(i (iY� f�f <br />a�uMsiNc <br />NO. TYPE OF FIIfTl1NE OR <br />WATER CLOSET �TOIIET) <br />BATHTUB <br />LAVATORY�WASMBASIN� <br />NITCNEN SINN { OISP <br />DISMWASMER <br />LAUNDRYiRAY <br />CLOTHES WASMER <br />URINAL <br />DHINKING FOUHTAIN <br />FIOOF DRAIN <br />BACKFLOW PREVE I <br />� ei�EtB�tn <br />T-'- <br />� ISE 20Ni <br />�' 2 <br />�r1•E O[ CON51 <br />gN <br />'�,ve or mDa <br />//93 '➢� <br />]qilON �LC B� <br />6UD TOT�L <br />PERMIT <br />TOTAI FE[ <br />Of ARk�� <br />N�i <br />.Z <br />V�f.�NT S11E <br />orEs teao <br />�. <br />i L <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP- <br />PLICATIONAND KNOW THE SAMETO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF IAWSANO ORDINANCES GOVERN�NG THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECiFIED NERE• <br />IN Op NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OP LOCAL lAW REGULAI'ING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN�IOREOFCONfRq�TOflORqUTHOBIZEDAGENT pqtE <br />X ���. ��� ���9,� 7 <br />P{`LICANTS f.Rv Puciuocd/ m� uee .... o <br />MECHANICAL <br />FEE NO. TYFE OF EOUIPMENT <br />A/C — A/HNDL6 UNITS — M.P. <br />REFRIGERATION UNITS —HP. EA. <br />BOILERS — B.T.U.M P. <br />6AS FIRED A.C. UNITS — B.T.U. <br />FOHCED �Iq SVSTEMS — B.T.U. M EA. <br />WIILLMEATEFS—B.T.U. M <br />UNIT MEATERS — B.T.U. IA <br />EVAPORATIVE COOLEPJ <br />CLOTHESONVERS <br />VENTIUTION FAN <br />HANGEHOOD <br />WATEN HEA <br />wOOD51 <br />Ni11T PUMP <br />GAS PIPING <br />E%NAUSTFRN <br />8 CHIMNEV <br />SU! TOTAL <br />PLPMIi <br />TOiALFEE <br />%.AN ^CHE .N NUMBER FEE <br />G' / I��� �� <br />FEES <br />DUILOING <br />PLUMBING <br />MECNANICAL <br />OTHER <br />SiATE BUILDING SURCHARG <br />STATE ENERGV SURC4AIiGE <br />PUB�IC WORK9 <br />5 <br />� IRECEIPT NO. <br />�i�\� <br />� I /� I L• G. TOTAL n�, I I <br />' <br />ULIA/�Q� OF �,� ,Q���,V 1.1,�'r PROPERiYOWNERSARERE5PON51BLEFORDETERMININGALI <br />�� � {,' �y ��,�y J C,��C� PROPEHTY LINE LOCATIONSAND RELATED EASEMENTS. <br />Y <br />'m�t R�s l�a. Ae'ti►+ sg� i,.�Wr 6� 1'aa.+�o� . <br />