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� ,� evere <br /> ev,erett PERMIT �,,_ <br /> CIIY Ilrtll )59tl405 <br /> EVI PLf'.N�SIIINfiJH <br /> eemi <br /> °"'' n[vnaruc�xr QUILDING MECHANICAL PLUMBING <br /> �_ <br /> OWNEIi MAIL AUURESS ZIP I'I10NL <br /> ��it�� %e". .�....T.....�r Z��",��! <br /> AFCHITFG� OR �ESIGNEIi MAIL AD�RESS PHONE LICENSE NO. <br /> � <br /> GENEf1AL CONTflACTOR MAIL ADDRE55 PHONE LICENSE NO. <br /> S "F`� _�T�?T �'+', <br /> h1ECHANICAL CONTflACTOR MAIL ADORESS PHONE LICENSE NO. <br /> PLUM[IING CONTRACTOR MAIL A�DFE55 PHONE LICENSE NO. � <br /> W <br /> m <br /> � <br /> PERMI"f CLASS OF WORK � <br /> z <br /> [� DUILDING � PLUM�ING ❑MECHANICAL � <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑PEPAIFl � <br /> VALUATION OF WOFK y� � <br /> �� [�DEMOLISH ❑FENCE ySIGN ❑SWIMMINC POOL w <br /> s °' <br /> DESCRI9E WOFK �O Q� <br /> }..�T n T^n �. t � r` !r'•'• �il ; 0 <br /> . . Cia "r. iS'lLtild -i: i lTs� .. �t{�Lfi C <br /> PpOPOSED USE MFCHANICAL <br /> TYPEOf- FUEI. �OIL �`ns. �LPG. �ELEC. <br /> LEGAL DESCPIPTION OF PROPERTY ISIiDW BELOW OR ATTl�CH <br /> FOUR COPIESI " <br /> NO. TYPE OF EQUIPMENT FEE <br /> LOT 6LOCK_OF — qIRCOND. UNITS-N.P. E4. S � <br /> REFRIGERl�TION VNITS-H.P. EA. <br /> �OILERS-N.P. EA. I <br /> GAS FIfiED A.C. UNITS-TONNAGE EA. T— <br /> FORCED AIR SYSTEMS-�.T.U. M EA. I <br /> JOO AODqESS {���y� Wl1LL HEATEftS--�.7.V. M --� <br /> ":T�✓ '��'��-`��� 5��+� UNIT HEATERS-B.T.U. M I <br /> EVI�POftATIVE COOL[RS <br /> PLUMBING CLOTNESURVERS � <br /> VENTILATION fAN <br /> RANGEHOOD � <br /> NO. TVPE OF FIXTUqE OR ITEM FEE AIR 41AN�LING UNIT- C.F.M. <br /> WATERCLOSETITOILET) g INCINERATOR � <br /> [�ATHTU9 <br /> _ L/1VATORV(WASH BASIW I I <br /> SHOWER <br /> KITCHEN SINK & DISP. .".UB TOTAL 5 I <br /> 71SHWASHER PERMIT 5 <br /> I <br /> LAUNDftY TRAV TOTAL FEE 5 I <br /> CLOTHES W4SHER 71115 PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUC- <br /> '^�ATER HEATER �— TION AUTHORIZED IS NOT COMMENCEO WITHIN 120 DAYS, OR IF <br /> U�iINAL CONSTRUCTION OP WORK IS SUSPENDED OR A�ANOONED FOfl A <br /> DRINKING FOUNTAIN PERIOD OF 120 OAVS AT ANV TIME AFTER WORK IS COMMENCED. <br /> FLOOR-SINK OR ORAIN I HEREBV CEFTIFV THAT I HAVE READ AND EXAMINED THIS AP- <br /> VACIiUM 6REAKEflS PLICATION AND KNOW �HE SAME TO �E TRUE AYD CORRf:GT. ALL <br /> _ PROVISIONS OF LAWS /1N0 OFDINANCES GOVERNING THIS TVPE <br /> ROOF DRAINS-RAINLEADEFS OF WORK WILL �E COAIPLIEO WITH WHETHER SPECIFIED NEREIN <br /> SINK IiERVICE-OAR,ETC.I OR NOT, THE GFiaNTING OF A PERMIT DOES NOT PRESUME TO <br /> — GIVE AUTHORITV TO VIOLATE OR CANCEL THE PftOVISIONS Of <br /> ANV OTHER STAT[ OR LOCAL LAW REGULATING CONSTP�UCTION <br /> OR TNE PERF]RMANCE OF CONSTRUCTION. <br /> SUB TOTAL <br /> PEftM1T 5 <br /> TOTAL FEE S ry}f�)� <br /> x .�., > r r <br /> SIGNATUFiEOFCONTFiACTOFORAUTH.AGENT DAT[ <br /> I SIDEYARDSETOACK STREETSETBACK REAF�'AROSETDACKPLANCHECKNU�IB[R PLANCHECKFEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANTSITE <br /> ['YES ❑NO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCV GROUP NO.OF DWELUNG � <br /> UNITS <br /> � <br /> I <br /> ISI2E OF F3LDG. NO.OF STORIES MA%.00Q LOA� BUILOING 5 {� <br /> I PLUMBING � <br /> RRE 20NE BASEMEPIT RFESPRINKLERS � <br /> RfOUIRED �,��CHAHICAL I <br /> ❑VES ❑NO <br /> SPECIAL CONDITIONS: OTHER I <br /> �y. I <br /> '.:f.� 1'�� -1Y 1.�.}*`�rr'���fa� �`'ii r��Ffff,� � � ' PENELTY SEC. 3031a1 � <br /> I <br /> +..�rT: � ±^�F-� �� r�'��':' 'q:;:pi �.,T' TOTAL �� I <br /> PERMIT VALIDATION <br /> WH[N PROPERLV VnL10ATED (IN THIS SPACE)THIS IS YOVR PERAt1T <br /> [l�' <br /> nr�ruo�rionnar.�imor�. r�nnscNecrcmirr�. nvrnoctoFoinssunNc[ov. <br /> �il{�r <br /> � <br />