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�1'PLICATION FO� ���,�„ <br /> M�EwrprNn CONSTRUCTION O <br /> pn oF <br /> everet� PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> JWNEN MAIL�DURE55 LIIY ZIP PMONE <br /> rjN,U/L% DPt/GNL 4fJ�/ CYC2CRr�� wAY cYtRSTJ- 2J-2-J�OD <br /> �RCNITEGTOROESiONER M�iLAODPESS Citt ZIP PMOHE . <br /> 3ENEHILGONTR�GTOA M41L AOORESS C11Y ZIP PMONE 4GENSE� <br /> Sun�'a�oR FlPf ADY w �ii� ti��.4�� REa.�+�No �'e�z . 9ti •o�r� svv�e�� /YJ J.u_ <br /> AECN�NIC�LCONIH�Lipq MML�UORCSS CIIY ZIP PNONE 4CENSE <br /> 'LYM�iNOCONiP�CIOP MMLApOl1F99 CiTY SIP PIIONE UCEN�E• <br /> 'r1i11380F WOPa <br /> IE7 NEW ❑ ADDIiION ❑ ALTERA710N ❑ REPAIR ❑ DEMOLITION ❑ WOODS70VE/FHPL.INSERT ❑ BUILDING RELOCATION <br /> /�LWTION OF WOPN W09T O�MAILOIAL'i PWS L�BOfil <br /> '� � 00 c o <br /> �EOCRIOE WONK <br /> �G S S o �hl.L <br /> �seovew�oir�a I HERcBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW TFIE SAMETO BETRUEAND CGRRECT,ALL <br /> EO�LDESCR�PTIONOFPIiOVEPTY�5110WN0ELOWORRI1RCNfOl111LOPIE51 pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPF <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> or_e�oac.--oF IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> � � GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . ��J,f <br /> 91aNATUREOFGONTRACTOflORAUTHORI2ED�0ENT OATE <br /> X ,�;� ".u.�.d1..,, 9 �. 3 �G <br /> 'NOJEG7�DONE59 APPLIGANiS GIiY BUSINESS IICENSE NO. <br /> 7 � <br /> �LUMBINO � MECHANICAL . <br /> NO. 1YPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET TOILEp AIR COND.UNI7S—H.P.E0. � <br /> BAiHTUB REFRIGERATION UNITS—H.P.EA <br /> LAVATORY WASH BASIN� DOILERS—H.P.EA � <br /> ' SHOWER OAS FIflED AC.UN�TS—TONNAGE EA . <br /> KITCHEN uINK6 DISP. FORCED/�IR SYSTEMS—B.T.U. M EA. � <br /> DISHWASHER WALLHEA7ER5—B.i.U. M � <br /> LAUNDRYTFAV UNITHEATERS—B.T.U. M � <br /> CLOTNE9 WASHER EVAPORATIVE COOLERS - , <br /> WATEH HEATER CLOTHES ORYERS . <br /> URINAL VENT�LATION FAN � <br /> OR�NKINOPOUNTAIN ' �RANGEHWD . <br /> FLOOR DRAIN AIR HANDLINO UNIT— C.F.M. <br /> VACUUM BNEAKEiiS 51"OVE <br /> ROOF DRAINS—RAINLEADERS METFL FIREPLACE 8 CHIMNEV � <br /> WOODSTOVE/FIREPLACE INSERT � <br /> SINK SEPVICE—BAR,ETQ . <br /> SUBTO7AL SUOTOTAL s �� <br /> PERMIT f PEIIMIT S . <br /> TOTALFEE f TOTALFEE 3 � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEI'T. PERSONNEL <br /> 10N79ElBAGK pEARSETBACK SID65ET6.�GN PLANGNiGKNUMBER PIANCNECNFEE � <br /> � IEE REGEIPiNO. <br /> iEZONE �OT�NE� y�CANTSITE V�IU�TION FEE <br /> FEES <br /> OYES aN0 <br /> � 1 <br /> �PEOFCONST. �CUPANCYGPOUP NO.OFOWELLINOUNITS <br /> BIIILDINO s � � <br /> 2E OF BLOQ NOAF SiORIES MAIC OG6 LO�D <br /> - ' PLUMBIN6 �� <br /> MECH�NICAL <br /> IRE SPRINKLERS REOUIRED O YES ❑ NO ' 1, � <br /> OTHER <br /> > I . _— <br /> PENPLTV <br /> '>LICAiION RGL.BY PUNS GHECNEO BY �PP0.FON ISSU�NC ; . <br /> �Lo TOTAL <br /> � <br /> /' <br /> �- z4•8� <br /> _. �.,. -- ._. _ <br /> �, . _ ....., ,- �, . . ..: .� , _. .- , <br /> . . _ �. .. _ _ . _ <br />