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FOIFJ <br />�VPfeH <br />NI <br />CITCITYGE <br />._APPLICATION <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK. PLEASE PRINT <br />0 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />U. SIGN <br />OW RER <br />r��G <br />MI, IL ADDRESS J CITY ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADORE53 CITY IP <br />PHONE <br />O(NENAL CONTRACTOR 7"7—MJUL AGGRESS IIY ZIP <br />a DI/lo y aoel'r rx<i�� yY42E� <br />�i/llu e/ .rP Ail [i //_.s `AEU;fir <br />PHONE <br />-- >/? �.�:i <br />LICENSE <br />I�i1�+7�1 <br />.._. .. <br />PLUMBING CONTRACTOR MAIL ADDRESS L. LP PHONE LICENSE <br />// -A/c <br />CLASS OF WORK � <br />❑ NEW ❑ ADDITION ❑ ALTERATION E/ REPAIR ❑ DEMOLITIO14 ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION_ <br />W WATIF WORK ICU51 UFF NAAFI I LS PLUS LABORI <br />'/ 2 .5 ccC'.. i c < <br />O]N/yJp <br />DESCRIBE WOR%7 / r✓ ! N/l f('4l'//• / `/N// S //i� /�4''�L.. /Il l N / <br />USBDF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />`)/'y,L7 //7 PN/ <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OFLAWS AND ORDINANCES GOVERNINGTHIS TYPE <br />CEOµ DESCRIPTION OF FROPERTTOSH NBELOW OR ATTACH FOURCOPIESI <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT­ BLOCK OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE. PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHOR AGENT DATE <br />i 2 / <br />X /3 ' .{ 4' <br />, <br />APPLICANTS <br />CITY SUSIN SS INSE NO. <br />PROJECT <br />ADDRESS / <br />/eve. <br />2 <br />Z> se) // �FY r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />REFRIGERATION UNITS-H.P. EA <br />BATHTUB <br />BOILERS-H.P. EA. <br />LAVATORY IWASH BASIN) <br />GAS FIRED AC. UNITS -TONNAGE EA <br />SHOWER <br />SINK A DISP. <br />FTTRCED AIR SYSTEMS-B.T.U. M EA <br />KITCHEN <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />UNIT HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />OLERS <br />CLOTHES WASHER <br />RS <br />WATER HEATER <br />N <br />a0m <br />�- <br />URINAL <br />DRINKING FOUNTAIN <br />NIT- CF.M. <br />FLOOR DRAiN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE & CHIMNEY <br />ROOF DRAINS-RAINLEAUERS <br />WOODSTOVE/FIREPLACE INSERT <br />SINK (SERVICE -BAR. ETC. <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT S <br />PERMIT S <br />TOTAL FEE f <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNLL <br />PLAN CHECKFEE <br />FRONT SETBACK <br />REAR SETBACK <br />1 A / /]. <br />�i <br />SIDE SETBACK <br />PLAN CNEC NUMBER <br />�� /�` /T� / <br />( <br />P <br />FEE O <br />RECEIPT N <br />USEZONE <br />LOTNIEA <br />A <br />VACANT SITE <br />OYES B(NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PL JMBING <br />SZAj�(A'.V190 <br />✓ <br />, <br />TYPE OF COMB ��. <br />_or`BBLLDG <br />OCCUOAI-CYIGROUP <br />NO. OFp2LIN0 UNITS <br />SIZE <br />N A <br />NO. OF STORIES <br />I <br />MAX OCC. LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES WNO <br />OTHER <br />PENALTY <br />TOTAL <br />/ <br />APPIICATIONACC BY <br />E.a) <br />PUN4 CHECKED BY <br />I jer <br />APPR. FOR ISSUANCE BY <br />I L.c. <br />