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Argrsen . <br />JF <br />verett <br />LDING DEPARTMENT <br />❑ DEMOLITION <br />M. /,,. <br />APPLICATION FOR <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ COMBINATION M BUILDING O MECHANICAL <br />MAIL ADDRESS CITY ZIP / <br />❑ PLUMBING <br />❑ SIGN <br />ARCHITECT OR DESIGNER/ <br />'MAIL ADDRESS <br />CITY <br />/ ZIP / <br />PHONE <br />/7�!-!f/t=L/ C�2/4ri/'I <br />1-F %�iti - /e4 <br />�^ <br />.ST <br />y. <br />iJ r�RL/.vIGTOn. <br />%f"L35 <br />GENERAL CONTRA TOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICE SE. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />PLUMEING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />CLASS OF WORK <br />SS <br />LYJ NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />- <br />❑ DEMOLITION <br />,,_, <br />0/ <br />WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATI011 OF WORK [COST OF MATERIALS PLUS LABOR) <br />CV <br />DESCRIBE WORK " <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU E CON AC OR ORAU HORIZED AGENT DATE <br />X <br />i <br />LEGAL DESCRIPTION OF PROVER BELOW OR AITACM FOUR COPIES) <br />LOT-5fSLOCK-6-OF i `-_ d /`a+ V <br />PROJECTADDRESS <br />/ <br />7NTS CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />_ <br />SINK (SERVICE -BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />.SUB TOTAL <br />SUBTOTAL S <br />_ <br />PERMIT $ <br />PERMIT S <br />TOTALFEE S <br />TOTALFEE & <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING <br />DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />Y6 <br />/ <br />1 <br />-�yP-LAN <br />FEE 15 / films <br />CHECK FEE <br />RECEIPT NO. Mob <br />V L Y <br />USEZONE <br />IOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />E <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC, LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />T� <br />TOTAL <br />