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A►PPLICt+T10N IFOR CONSTR.�CT10R1 <br /> IPERNIIT <br /> fha Evargreon ''"'fO�� <br /> GTY OF � <br /> ever�ett <br /> BUILDING DEPARTMENT <br /> 25s-88i0 TO BE COMPLETED IN INK— PL;ASE PRINT <br /> ovirverv <br /> r.�ni�noonEss cnv a,v vuorvt <br /> y � H l�G�t�YaAu1NoR[C-fc��G�Co��"Cf L`�TM� P,,c,�l.� _�-V�.,,�–�IE�7pL— ------ - <br /> � � iENAM ��%�ILPDDALSS N�IOM1E <br /> H II — <br /> p y y — — __ — r,,iv__. —__-li' - v��oHe <br /> ❑ � H q�����"IG� 6�AILADURESS <br /> �y ' �/�`J a D I 4t:Pl'loa�o <br /> K � � �NERALCONTRACiOfi � ��'"�C������IY � I�P PIIONE UCENSE• <br /> H � __�{ p31D __ --- <br /> �7 � �U U.�CHANiCPLCONtRACiO�� 1.1a;L��D!]iLSS CIiY -----ZIV PI�ONE LICENSC♦ <br /> N M �' <br /> � z -- I.URFO���!3S - — CITY Z"T PMONE LIGGNSEa <br /> C9 y O VW1dBRlGCONTRAGtOA ' <br /> oN I <br /> � R1 n ClASSOFWOPK <br /> G �, NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLI710N ❑ V/OODSTOVE/FPPL INSERT ❑ BUILDING RELOCATIUN <br /> Z H $ ^_ONTAG�PERSONANOP110NEN0. <br /> b H ,L�V tENANi1MPROVEM[NIORIMEPIOPREIAO�EIONLY <br /> �� /q <br /> ~ y GONiRACiPRiCEOLWOFK ` V�� <br /> G7 N <br /> O H oescaie[u�oannnosouAeeroornc�irrvoivco <br /> (� O N '�J G I <br /> � °e r p� ��-�����1—�1�� <br /> pJ qaaak s� auaoi�+c � IHEFEBYCC-RTIFYTHATIHAVEREADANDE%AMINEDTHISAPPUCATIONAND <br /> y HO N �»LA��� KNOW?HESAMETOOEiFUEANDCORREGT.ALLPFOVi510NSOFLAWSAND <br /> ORDINANCES GOVERNING iHIS iVPE OF WORK WILL BE COMPLETED WITH <br /> �ECAic�s �+i�'i�or�oranooeanisNo�m�ee�owonnr*r�cHFOUnCOPiE�i WHETHERSPECIFIEDHEREINORNOT.THEGRANTWGOFAPERh11TDOE5N0T <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �or e�aCK oF FORMAM10E OF CONSTHUCTIONJ NE T�1 AM AUTHORRED BV�H�OWNER OF <br /> �� — I,.� ���,i�/ THISPROPERTVTOPERFORMTHEWORKFORWHICHAPPLICATIONISMA�E <br /> � G 1 AND I COIdPLV WITH THE STATE CONTRACTORS LAW 1827 FCW AND <br /> 296200�'AC. <br /> SIGNniUREOFCONiRACiOROF.'.UIMOAIZEOAGENT OAiE <br /> 1��L����.VE .--5-k�►-L�.���le� X -- <br /> pHOJEGi P��PE55 hPPLIG4Ni5 CITY BUSME55 L�CENSE NO ANO AUSINESS NAI.!E <br /> -r,�,_. .-���'� ,3or� v � . �, <br /> PLUMBING MECHANICAL <br /> /� NO. TYPEOFFI%TUREORITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> ( 'a=1� � WATERCLOSET�TOILET� _Q A/C—A/HNDLGUNITS—H.P. _ <br /> � BATHTUB FORGED AIR SVSTEMS—B.T. EA <br /> � LAVATORY�WASHBASIN) , UNITHEAfERS—B.T.U.3M <br /> SHOWER y CLOTHESDRYERS <br /> I 'v� �� _ VENTILATION FAN . <br /> KITCHEN SINKB DISP. 0 <br /> a��1 DISHWASi1�R __Q F7ANGEHOOD <br /> ' LAUNDRYTRAY, WATER HEATER , <br /> CLOTHES WASHER Q WOOD STOVE � <br /> ��� Q URINAL _(� METAL FIREPLACE 8 CHIMNEV� . <br /> � �� �_ DRINY,INGFOUNTAM � Q FIREPLACEINSERT �\ <br /> FLOOR DRAIN O HEAT PUMP <br /> � BACKFLOW PREVENTERS �\ '�f GAS PIPING � <br /> /� ROOFDRAINS—RAINLEADERS� �� E%HAUSTFAN � <br /> ���� �_ SINK�SERVICE—BAR,ETQ) �.. <br /> ., \ <br /> ' � _ <br /> \ <br /> ��t I - \ — <br /> , � SUBTOTAL 5 SUBTOTAL $ __ _ <br /> � PERMIT 5 —___�'ERM1IIT_ . _..__ 5 ___ _ . <br /> � ' <br /> TOTALFEE B TOTALFF[ 5 I <br /> ���i' — PIANCNEG UMOER �EE REGEIPTNO <br /> � FRONT SETBACN RERR SETBACK 517E3`ETBAEK'� i <br /> r� a � v 3 i <br /> V�CANi51TE FEES VALUATION FEE , <br /> USEZONE LOTAFEA . <br /> G —� �� 7�. j F � YES � N� pUILDING 5 (,}� � <br /> 1vP[OFCOx�ALLOIYFBLE ivPEOFCONSt.AG7UFL accunr.cr r,oaro�xtwrcu5ns T ��� <br /> ��1°' 8 PLUM�ING � <br /> 1 2-/ <br /> , <br /> SIZEOF9LDG_ NO.OFSiOflIES DASEMENT MECHANICAL �� <br /> 7 f 8 I ! YES NO <br /> OTMER �I �.y I�. i . <br /> O L P�NLV LOAD FIRE SPRNKLERS/1FB'S HEIGNT I`.IMfItqTlOY i <br /> U� xYES � : NO O� STATEBl11LDINGSURCHARGE �-�_i�� 1 <br /> �i <br /> � PEISON FOR SPqINKLERS � i <br /> STATEENERGVSURCHARGE � j <br /> i <br /> qpp��gµ�(,�g.gy PLANSFPPROVED�Y CITYOFEVEREIT PU�LICWOHK$ � <br /> =r�*uk. LOCAL SALES <br /> ti( ii,1 �� TAX CODE IS 3105 T�Tp� � ��5 ' Z <br /> �\ : , � � � <br />