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/�wPLICATiON FOR�-� everelt <br /> Ihs Er�rprs�n C O N S T R U C T I O N e <br /> QiY OF <br /> everet't PERA�IIT <br /> TO BE COMPLETED IN BLACK INK— PLF:ASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHAh'ICAL ❑ PLUMBING ❑ SIGN <br /> WHy� M�ILFODf1E55 CIIY ZIP PMONE <br /> �r�sr�� �� �lo /� �sa /l /`I�.C��.�.�...v� �v ... t,�= lJa �'�-��/ �- 5-` -!�'t3' _ <br /> •RLHIIECt0�10E51GNER MPILRDURE59 CITY ZIP PHONE <br /> ��GE/Nf��'}LCONIf1BC/t/0g / MAILAO�PESS Cltt ZIP PIIONE ��CENSE• <br /> 7J c^�/'r J (/ � �l� �s.>..,! <br /> A1ECN�NIGALLONIRACTON MAILAOOf1ES5 Clll' ZIP P110NE ��CENSE• <br /> PLUMBINOCONfRAC10� MAllA0DRE55 L17Y 21P PHONE ��GENSE� <br /> CLA55Oi WORN <br /> ❑ NEW �C AODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE��I7PL.INSERT ❑ 6UILDING RELOCA710N <br /> ' VRLUAt10NOFWORN�COSTOFMAIERIRLSPW5LA00P1 <br /> X �! U ooa <br /> oESrqieEwO K �//� � <br /> � � fA 1-J l..- Q ^�� ti 1- <br /> USEOF 9UILOINO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> �� � � „, ,, � PLIC1ITIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEOALOP C�IPIIONOFPROVERfV IIOWNBELOWORATtACMFOURCOPiE5) pROVISIUNSOFLAWSANDORDINANCESGOVERNINGi�HISTYPE <br /> OF WORK WILL BE COMPLETED N'ITH WHETHEF SPECIFIED fiERE- <br /> �or_e�oc�—oF — IN OR NOT.THE GRANTING Of A PERM�I'DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> �� � 7 � O�— Z '�O hO— /JUO ANYOTHERSTATEOP.LOCALLAWREGULATINGCONSTRUCTION <br /> T—� �( OR THE PERFORMANCE OF CONSTRUCTION. <br /> � TURE OF CONTPACTOfi OR AUIHOflIZED AGENi OA7'c <br /> _ d N� n.. t.�- ,��� l <br /> �,, o..`�c,� .t l 9�t� <br /> ����=� ���/=� 3 !9-� <br /> P4GANi5 CITY DUSINESS LIGENSE NO. <br /> PpOJECi�00RE5S <br /> I\_.. / r ( ).t�" <br /> �PLUMBING � � MECHANICAL ---- <br /> NO. TYPE OF FI%TUflE FEE NO. TVPE OF EOUIPMENT FEE _ <br /> � K'ATEflCLOSET(TOILE7� �� A�RCOND.l1NITS—H.P.EA. <br /> � BATHTUB OO REFfliGERATION 11N1T5—N.P.EA. _ <br /> �AVATOi7Y�WASH BASIN) BOILERS—H.P.EA _ <br /> SHOYlER GAS FIRED AC.UNITS—TONNAGE E0. <br /> KITCIIEN SINK.4 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALL HEATERS—B.i.U. M <br /> LAUNDPV TRAV UNIT HEATE(75—B.T.U. A1 — <br /> CLOTHES WASHER EVAPOPATIVECOOIERS <br /> WATER HEATER CLOTHES DRYERS - <br /> VENTILATION FAN — <br /> UF7�N�l <br /> DFINKING FOUN�fAIN RANGE HOOD <br /> FLOOR OPA�N AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS �70VE <br /> FOOF DFiAINS—RAINLEADERS METAL FIREPLACE 8 CHIMNF.V <br /> S�NK SERVICE—BAF.ETC. WOODSTOVE/FIREPLACEINSERT — <br /> SUB TOTAL � SUB TOTAL 5 - _ <br /> PEflMIT 5 PEflMIT 5 <br /> TOTALFEE S TOTALFEE 5 � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> PLAN CNECK NUh1�ER 7��PU� N GIIEGH fEE <br /> iPONt SEIO�CK RER115El0ACK SI�E SETBAG� � � ��/ FEE !� %- AECEI'��`� �� <br /> "G I,.__ S g [� � � <br /> ,�.� .. <br /> USE20� ��tARE� VAChNT51T FEES VALU/.TION FEE <br /> �. 2 OYES <br /> TYPEOFCOt-SA` OCC.UDi'�L;GROUP � NO.OFOWE'LINGUNIiS BUILDlNG <br /> V I 4 fJ R �l � �O �� �\ <br /> StZEOFOLOG. NO.OFSIORIES MAICOLC.LO�1D pLUMBING �U (JV <br /> �d;a 5.� 1 Np. <br /> �� MECHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ YES Cd"NU OTHER <br /> PENALTY <br /> BPPIIGAlIOH ACL.BY P�A��S CNECY,EO BY RPPR.FOR ISSURNCE BV q'^ � <br /> TOTAL ! �i <br /> � �� ��t�1�� �-• G'. <br />