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r <br />--,�PPLICATION F(y�rt <br />fhe Eveigreen c� N S T R U C T 1 O N <br />CITY OF <br />evereLt PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEA: E PRINT <br />BUILDING DEPT. <br />259•B745 <br />owuen <br />❑ CORABINATIOIJ ❑ BUILDING ❑ MECHANICAL � PLUMBING '� SIGN <br />, Mni�nooness cirr zir vuoNe <br />MAIL <br />r.�na <br />z�r <br />T.il� q'J�"se�-- <br />� <br />Gr ,c.i•a_na <br />PLUTAOINOCONTflhCTOf1 MAllF0��E55 UIY ZIP PIIONE LICENSE• <br />CLASS Of WORN <br />❑ NEW ❑ ADDIiIC�N ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FR('L.INSCRT ❑ BUILDING RELOCATION <br />V�LUAIION Oi WOFN �COST OF MN[f11RL5 PLUS LAOOfi� <br />.i nJ-'. <br />��; <br />�U SCRIU�WORK .� . .�� � <br />. .�i.I/ c.,�iL %%';�� �•�.� c,:.. ,�ac,�;li�..� 5 2i.r., <br />�ecn,oesc <br />ior_ <br />PROJECI <br />I FIEREBY CERTIFY TF1NT I IiAVE READ AND EXAMINED TIiIS �P• <br />PLICATION AND KNOW THE SAMETO BE TRUEAND CORRECT. ALL <br />ORATTRCNFOIIRGOP1E51 PROVISION;OFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE CU�viPLETED WITIi WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTINC OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEHFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRAC70R OR AUilIORI2E0 AGENT DATE <br />%�CJ �] �/�c-."—.`%'Li.t.�J <br />TYPE OF <br />IPS LIIY OUSINE55 LICENSf HO. <br />/�o %ao <br />NICAL <br />TYPE OF EOUIPMENT <br />41R COND. UNITS—H.P. EA. <br />REFRIGERA710N UNITS—H.P. EA <br />BOILERS—H.P. EA. <br />GAS FIRE� AC. UNITS—TONNAGE EA <br />FOf7CED AIR SYSTEMS—B.T.U. M EA. <br />WALL HEATFRS—B.T.II. M <br />IINITHFATFFS—BT.II. A1 <br />THIS PORTIOf� TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONi SEIDACK ��Enf� SELURCN Si�E SE*ORCK PLAN CMECN NUTApLl1 �'tAN CILLCh I LL <br />FEE �ECEIPi N0. <br />USE20NE LOIAPEA yp�qryT51TE <br />❑VES C1i0 FEES VALUATION FEE <br />TYPEOFCONSi, OCCl1PnNCYGROUF NQOFDWELlINO11NIi5 <br />SIZE OF 0�0a. � NO <br />BY I � =����� CH[GKED Bf <br />aui�oiNc $ <br />lAAIC OCQ LOAD <br />PLUh7BING <br />MECNANICAL <br />OTHER <br />FENA�TV <br />qPPq.FORISSIM!!G B� Y <br />�j� � TOTAI <br />0 <br />Z <br />O <br />�--� <br />(") <br />m <br />..� <br />--a -n <br />.-. —i <br />cn x <br />m <br />c o <br />m� <br />.-i c <br />0 3 <br />�_ <br />2 ---I <br />m <br />A Z <br />a -i <br />rx <br />�--� �--i <br />--� N <br /><� <br />O A <br />'T1 D <br />�m <br />S <br />m �-+ <br />N <br />O <br />or <br />�m <br />C VI <br />f3l VI <br />z n <br />--� r <br />. m <br />a <br />z <br />� <br />x <br />a <br />z <br />� <br />x <br />N <br />0 <br />-� <br />n <br />m <br />