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, „ ,,. . <br /> � APPLIC/�TION FG .t e�erett <br /> I�r EverprNn C�N ST R U CT I O N � <br /> cin or <br /> ewerett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECNAtJICAL ❑ PLUMBiNG ❑ SIGN <br /> OWbER MRI!.�OOPE55 GIN ZiP PHO��E <br /> �r I A . ?�c�c, n aao9 �n,�C�lua �ver�H- 9�saoi 33�! -a��3 <br /> MC�lOR0E5�GNER MRIl�U0PE5S Cltt ZIP Pi�ONE <br /> GENERnICONIP�G�OR MAILR�Ol1E55 Gltt ZiP PHONE LICENSE• <br /> MECH�NIULCONiRACIOfl MAILRODHESS CIiV 21P PNON[ II�ENS[• <br /> � a v�, n �-.�r�.! ' 94 - ���er�-H- 4�N��-��3o vA�.�nU��3�-r <br /> PLUMBINf. ONI CTOR MAILRO�PE55 GITY ZIP PIIONE UCEN�E• <br /> CLA550�WORK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ 9UILDING RELOCATION <br /> y'l UA�ION Of WOFK`f,p$i OF MRtERIALS ALUS UBOR� <br /> 11 /'�l '�� <br /> �r �%Y/3 <br /> �[SLR�OE Wpf1N <br /> ,�i;�'}'C1.! � CCX"1 V� gLLJ"V'�1� =Y1 S�CLC� �CL--E' <br /> USE Of 9UROINO ^ ' 1 HEREPY CERTIFV THAT I HAVE READ AND EXAMIWED THIS AP� <br /> (�c.;l �� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEGALOESCRIPIIONOFPpOPERfY�5110tYN0E�OWORATTPCNFOURCOPIES� pROV�SIONSOFLAWSAIJDORDINAMCESGOVERNINGTHISTYPE <br /> OF WORK WILL 8c COMPLETED�VITH WHETHER SPECIFIED HERE <br /> ioi_eiocK—or IN OR NOT.THE URANTING OFA?ERMIT DOES NUT PFESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE GF CONSTFUCTION. <br /> SIGNAIURE OF WNTRACTOP OR AUTHORIZED AGENT DATE <br /> ��t�"� �' � U'-�hL�Q ���3v� �� <br /> PROJECT�OORESS APP�I TSCITY9USINESSLICENSENO <br /> 09 b �'l►� '�Uer�-W" <br /> PLUMBING _ MECfIANICAL __--_ <br /> NO. 7'YPE OF FI%TUflE FFE NO. TYPE OF EOUIPMENT _ FEE <br /> WATEF CLOSET(TOII.ET) FIR CONO. UNITS—H.P. EA. <br /> BATHTUB REFRIGERATION 11N175—H.P. EH. <br /> LAVATORV(WASH BASIN� DOILERS—H.P.EA. _ _ <br /> SHOWER GAS FIRED AA. UNITS—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. _ � FOFCED NR SYSTEMS—B.T.U��v1 EA. <br /> DISHWASHER WALL HEATFqS—B.T.U. M <br /> LAUNDRYTRAV UNIi i1FATERS—B.T.U. M <br /> CLOTHES WASHER [VAPOFATIVEI:OOLERS _._ — <br /> WATE7 HEATER CLOTHES�RYERS _ <br /> URINAL VEN71LA710N FAN -- <br /> DRINHING FOUNiAIN RANGE F100D <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. _ _ <br /> VACUUM BREAKERS STOVE -- <br /> ROOF�RAINS—FAINLEADERS METAL FIREALACE 8 CHIMNEV <br /> SINKISERVICE—BAR.ETC. WOODS70VE/FIREPLACEINSERT <br /> W <br /> SUBTOTAL SUB TOTAL 5 <br /> PEHMIT 5 PERMI7 5 <br /> TOTALFEE S TOTALFEE s — <br /> THIS PORTION 'i'0 BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONi SEiBAGN 11EAR SEIBACK SIDE SETBFCN PLAN CMEGH NU��9ER PLnN C�IECN FEE <br /> FEE RECEIPT NO <br /> USEIONE IOiAREF yqCANiSIIE FEES VaLIlATION FCE <br /> ❑YES ONO <br /> iYPEOFCONST. OCCIIPRNCYGROIIP NO.OFOWELLINOUNITS <br /> BUILDING E <br /> 512E OF O100. NO.OF STOPIES MR%.OLQ LOPO <br /> PLUMBING <br /> MECHANICRL <br /> FIRE SPRINKLERS FiEOUIRED ❑YES ❑ NO OTNER <br /> PENPLTY � <br /> AVPUC4110NRCC.BY FLRNSCHECkEDBY r1PPR.FORI55UANCEBY <br /> TOTAL <br />