Laserfiche WebLink
' � <br /> �f �heEverpreen ����PPLICAT�ON FO�' evcrett � <br /> ��TM�F CONSTRUCTION � <br /> e��erett PE RM IT <br /> TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br /> / <br /> OWNEH M�ILr1D�BE5S Gltt ZIP PMONE � <br /> N�r����N � 011 /9LicF�7 fff�tc/ �15USco//y E'�E�tE�/, G��o3 as�-a.�g <br /> � CMItECTOROESIGNEH MARA00lIE59 CiiY 21P PHONE <br /> GENER�LCONTflACTOR IAAILRODPESS CIiY ZIP PIIONE LICENSE• <br /> MECMANICRLLONTMGTOfl MAILRDORE55 Cltt 2iP PMONE LICENSE• <br /> FLUMBINOCONTRACTOR MRI�FUDRE55 GITY ZIP PHONE LICENSE• <br /> CLRSS OF WORN <br /> ❑ NEW ❑ ADDITION �ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOUSTOVE/FRPL.INSERT ❑ BUILDING F7ELOCATION <br /> z <br /> VALUATION OF WOqK(COST OF MRTEHIAl9 PlU9 LFOOR� � <br /> --� <br /> H <br /> n <br /> // J � m <br /> OESCRIOEWORK �i LLG��L" � "C'L/[�LJ/(/ L�/�� n�:� <br /> � cA"f'Z .JL,�i� L <br /> � L/ � �- �G�En Iizi��tc.�Z..l�>c,E c�, r�c�/ , J <br /> u eoFeuaoiNo, . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• -�-I T <br /> /� q / � <br /> yy'�:.Rt" � ♦I'I�� J� � cE�iic _ PLICATIONANDKNOWTIIESAMCTOBC-TRUEl�NDCORI9ECT.ALL M � <br /> LEGRLOESCRIP110NOFPPOPERtY�5110WN0[LOWOl1NTTACHFOUl1COPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHlSTYPE cnx <br /> OFWOHKWILLBECOMPLETEDWI7HWHETHERSPECIFIEDHERE• �^ <br /> LOT_BLOCIC_—OF INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO mo <br /> GIVE AUTHORITY TO V�OLATE OR CANCEL THE PROVISIONS OK n <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. 0 3 <br /> _p m <br /> � SIGNATUREOFCONTRACTORORAUiHORIZEOAGENT UAiElf��� O-5 = � <br /> m <br /> X �.� � . ��tc`� a � <br /> PROJECTAOORESS APPLICANiSCITYBU51NES5LICENSENO. r = <br /> 7S�/d El�c-�6.L�cE1� L!/f�f. G.-1.�.cG-7j- �1��0 � n <br /> PLUMBING MECHANICAL p p <br /> NO. TYPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT FEE '*1 3 <br /> WATER CLOSET(TOILEn AIR COND.UNITS-H.P.EA. _ �''� <br /> BATHTUB REFRIGERATION UNITS-H.P.EA fn �-+ <br /> N <br /> LAVATORY�WASH BAS�N� BOILcRS-H.P.EA. <br /> - uHOWER GAS FIflED AC. UNITS-TONNAGE EA O r <br /> c� m <br /> KITCHEN SINK 8 UISP. f� FORCED AIR SVSTEMS-B.i.U. M cA. � N <br /> DISHWASHER WALL HEATERS-B.T.U. M z n <br /> LAUNDP,YTRAY UNITHEATERS-B.T.U. M -im <br /> CLOTHES WASHER EVAPOHATIVE COOLERS � <br /> WATER HEATEF CLOTHES DRYERS <br /> URINAL VENTILATION FAN � <br /> 2 <br /> ORINKING FOUNTAIN RANGE HOOD Z <br /> FLOOR DRAIN Alfl HANDLING UNIT- GF.M. � <br /> VACUUM BREAKERS STOVE � <br /> ROOF ORAINS-RAMLEADERS METAL FIREPLACE 8 CHIMNEV (n <br /> SINK SEflVICE-BAR.ETQ a �1 WOODSTOVE/FIREPLACEINSERT . Z <br /> O <br /> -�i <br /> «-� <br /> C'� <br /> m <br /> � <br /> � SUB TOTAL od SUB TOTAL 5 , <br /> PERMIT S 11(� �EflM1T S ' <br /> TOTALFEE 5 D TOTALFEE 5 � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FflONTSETBACK REAfl5ET9ACK SID[SETBRCK PLANGMECKNUMBEfl P.LFNCMECKFEE <br /> FEE �ECEIPTNO. <br /> USEZONE LOTAREN ypCpNTSITE <br /> FEES �ALUPTION FEE <br /> OVES OHO <br /> TYPEOFCONST. OCGUPPNCVGNOUP NO.OF�WELLINOUNIT5 <br /> BUILDING 5 <br /> SIZE OF BLD4. NO.OF STORIES MAX OGG LOAO <br /> PLUMBIN6 (� <br /> MECHANICAL <br /> F�RE SPRINKLERS REQUIFiED ❑VES ❑ NO <br /> OTHER <br /> PENALTV <br /> APPLICATIONACC.BY PLFNSCHECKEOBY APPRFORISSUpNCEBY <br /> TOTAL <br /> 1 <br /> ...._._...__........_._....._.»._._....._.._.... . <br /> ` _ , <br /> 4 <br /> t�� .:�1i dT�< ''Y.�M> . .. <br />