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APPLICATION FOR' <br />eAeretl <br />the EY.,p.gn <br />CITYOr <br />CONSTRUCTION <br />� <br />evere t <br />PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />SIGN <br />sYNFn <br />MAIL ADDRESS C'IY ZIP <br />PHONE <br />�Y1Ci/b J`PEc i.aG <br />s 'Nin r.! /7�Do'-E >Ev i[[ v�.�. idn.a;�,l//J. <br />• CRIfECT On DE.IGNFR <br />MAIL ADDRESS 611Y ZIP <br />PHONE <br />iEN�E ML CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE A <br />///l1C�J'�Gt1[v- <br />/� <br />�yz /l�/.r/a2 A!/�E rF/ V '7LE /�/�� <br />�L�-�zyj <br />•flEif.G'Ai�R3HG <br />'AECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />UCENaE <br />�'LUMBVIO CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PNUNF <br />LICENSE it <br />rt;LASS OF WORK <br />liL NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUA TION OF WORK [COST <br />O1 F MATERIALS PLUS LABL.RI <br />11 <br />IIFSCRIBC WORK <br />/il/FfQi t �'C, ti L: rl'Fir (ia,ru �[�'L�71'Sl�ift` /,viE/A/nn /[ C L�4.•/id.4/. ��,1/ <br />JsE of BUILDING � � z.>r <br />v�iA/.tiG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF 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 />A iY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />C'R THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUREOFC b0PRACTORO ORIZF.D AGENT CATE <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT_BLOCK __0 <br />PRO IECt ADDRESS <br />APPLICANTS CNY BUSINESS LICEN. O <br />PLUMBING <br />MECHANICAL__ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ _ TYPE OF EQUIPMENT _ _ <br />_ _ FEE <br />WATER CLOSETITOILET) <br />AIR COND. UNITS_11 P. EA. <br />_ <br />BATHTUB <br />_ <br />REFRIGERATION UNITS—H.P EA. <br />BOILERS—H P. EA <br />GAS FIRED AC. UNITS —TONNAGE EA <br />FORCED AIR SYSTEMS-B.TU M EA. <br />WALL HEATERS-B TU_M <br />LAVATORYIWASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C. E.M <br />- <br />VACUUM BREAKERS <br />STOVE- <br />ROOF DRAINS-RAINLEADERS <br />_ <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />SINK SERVICE-BAR.ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUB TOTAL _S <br />_ <br />PERMIT S <br />PERMIT _ S <br />_ <br />TOTALFEE S <br />TOTALFEE___.._...____ f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />L <br />I <br />J <br />.i ■ <br />