Laserfiche WebLink
- . . . .. _ _...�. .. . _ , ._ _.. _ __,.�._. <br /> .1 -� <br /> `-��PPLICATION FG�t ���,�„ <br /> ��"'° CONSTRUCTION e <br /> ev�rett PE RM IT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �SICiN <br /> OWNER MAILAODHE53 Citt � ZIP PHONE <br /> /�li'JIFs�//��F �o - s E ��f.�r �,�ii w�ty s ,,� D r-�� �.-�r�r <br /> ARCHITECTOPDESIONEH MAIL�DDRE55 CITY ZIP PHONE <br /> QENEMLCONTNAGTOF M�ILADORESS Gltt ZIP PNONE LICEN9E• <br /> �t/flfio.�/�/ Si6�/ ��a-fr-�ro.�J izss c✓�sr��z� �E .v s��f � �,rr�sc-,cwf; <br /> MlpMNIOM.CONTMCTOq MAIL�DOPESS Cltt ZIP PHONE LICENSE• � <br /> FiFe�nZ�� �v.r�e.vA/ ci f� CeYD�i�fsa,✓ i 2 ts c..,�s77�Xf.kf,u .Si'j?7�HF GJXN N�►l.'�tR't.,tl/L i <br /> PLOMBINOfONTRACTOR MAIL�ODPESS Cltt 21P PHONE UCENSE• j <br /> �/,9. �''/n- N/A- N/r� N/g- �"/� ; <br /> CL 990FWORK <br /> �J NEyy �DDITION ❑ ALTERA110N�/ ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> ' �/� UATIONOFWONK�COSTOFMATEPI�LSPLUSLABO /��QQO� <br /> �NS�A�// ���D /Yl/}i��'i9i`n/ 'ONf N1� .�GC �..,�'�A�tl� t'i��� <br /> DESCRIBE WONK <br /> useoreuao�No '`/� ,�. 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS�AP-. ` <br /> � /� ^� �G�J�Tl�I/9�� PLICATIONANCKNOWTHESAMETOBETRUEANDCORRECLALL �1 <br /> LEQ�LDE9GRIPTIONOFPPOPEiiTY�9HGWNBELOWORATfAGMFOURCOVIES� PROVISIONSOFLAWSANDORDINANCESQOVERNINOTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE Ii <br /> �ot_a�x�—aF E �' INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO � <br /> GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF� <br /> � ANYOTHERSTATEORLOCALLAWREQULATIN(iCONSTRUCTION �I <br /> OR THE PERFORMANCE OF CONSTRUCTION. � <br /> SI6NATURE OF CONTRACTOR OR AUTNORI2ED AQENT D�TE I <br /> X A� e/��— �� 3�9 �: <br /> � , <br /> PROJECTAUDHESS � APPLICRNiS ITYBlI51N SLICE SENO. '` <br /> �l� ' �- -UE/F /yl E ��'fE 3 6 3 6 <br /> PLUMlINO l � MECHANICAL ; <br /> NO. 7YPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE �: <br /> � <br /> WATER CLOSET TOILE AIR COND.UNITS—H.P.EA � <br /> BATHTUB REFRIOEPATION UNITS—H.P.EA. ( <br /> LAVATORVIWA9H BASIN) BOILERS—H.P.E0. F[ <br /> � 9HOWER OAS FIRED AC.UNITS—TONNAOE EA r1, <br /> KITCHEN SINKB D19P. FORCED AIR 9Y9TEM5—B.T.U. M EA <br /> DISHWA9HER WA��HEATERS—B.T.U. M <'� <br /> LAUNDRVTfiAY UNITHEAIERS—B.T.U. M �� <br /> t' <br /> CLOTHE3 WASHER EVAPORATIVE COOLERS �,i <br /> � WATER HEATER CLOTHES DRYERS i�; <br /> URINAL VENTILATION FAN - ��� <br /> DRINKINO FOUNTAIN RANGE HOOD t; <br /> FLOOR ORAIN AIR HANDLING UNIT— C.F.M. `7 <br /> VACUI�M BREAKER3 S70VE <br /> ROOF DMINS—RAINLEADERS METAL FIREPLFCE 8 CHIMNEY ,I <br /> SINKLERVICE—BAR ETC. WOODSTOVE/FIREPLACEIN9ERT �,' <br /> (I <br /> 1 <br /> SUBTOTAL SUBTOTAL • �_, <br /> PERMIT 3 PEqMIT • ' <br /> _ TOTALFEE 3 TOTALFEE • j�. <br /> THIS POR"fION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL II <br /> FPONT3ETB�CK HEFRSETBACK SIDESETB�CK PLFNGMECNNUMBEN PUNCMECNFEE �I� <br /> FEE REGEIPT NO. � I <br /> �I, <br /> IlSEZ(][!E LOTRREA VAC�NTSITE FEEB `1ALUATION FEE ii <br /> C� `� OYES ONO I� <br /> � <br /> TYPEOFLONST. OCCUP�NCYGROUP NO.OFOWELLINGUNITS <br /> / <br /> B111L01NG 5 /- <br /> SRE OF BLD6 NO.OF STOPIES MAIC OCC.LO�D <br /> PLUMBINa <br /> MECMANICAL <br /> I <br /> FIRE SPRINKLERS FE�UIRED ❑VES ❑ NO O7HER �' <br /> PENALT`' <br /> APPLICATIONAGC.BY PLANSCHEGKE7 Y APPA.FOH159UANC� 1 <br /> � /% TOTAL <br /> r� ' <br /> r�� �;�:: <br /> , _� <br /> ':� <br />