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' tj."��,PPLICATION FO�►��I everen <br /> ' '".E"."°'"° CO N STRU CTIO N O <br /> cin oF <br /> ; everet�� PERM1T <br /> � BUILDING DEPARTMENT <br /> ; 259•0745 TO BE COMFLETED IN INK- PLFA�E PRINT <br /> � ❑ DEMOLITION , .`'.• ❑ COMBINATION �BUILDiNG • ❑ MECHANICAL. ,4 ❑ PLUMBING ❑ SIGN <br /> ,I OWNER • - MMUpORE55 �.Cltt 21P PNONE <br /> ; R. I�;� �,a�,�rd ',%O'I S��ver�e7yMa/�Gr,��v .S�'��9 �vev�ft G✓A 9�v'`��/ 3�5 -�oo / <br /> � CHITECTORDESIGN�E . MRILROORESS � Cltt ZIP PIIONE <br /> � �ana��lCus7,�.-, l/D�»e5�.��c. �D75��dcr�f}f�1/,��✓y5�-�"7 �vP.27�. t✓/� 9�'aD�/ 355 -�ao� <br /> � 0 GRALLONiHACfOP MAILAD�NESS Cltt ZIP PIIONE UCENSE• <br /> � �� f y ��/� ; � c� ��Zg� <br /> � xa�-. s�N� > o�����1Tr�; d�9SE �vevelY � G✓�v 5�,� 7 �v�, ,_c/ �.ZL� S <br /> � MEGM�NIG�LLONIRACTOq, MRILROOflEiS IY ZIP PHONE DI'-N/e`nCSH.C���q� <br /> I PLUM9INO�ON;R�CiOR� � � , MNL AOOPESS�.. Gltt IiP PIIDNE UCENSE• <br /> 1 t <br /> � f.U550FWORN <br /> 1 � <br /> � NEW ❑ ADOITION ❑ ALTERATION REPAIR DEMOLITION YJOODSiOVE/FRPL.INSERT BUILDING RELOCATION <br /> VALp/�/�OFD�� Si0'OM�tEflI�LSPLUSLRBORI <br /> � �, • _ <br /> DE,S�C/RIBE OHK f / ._/._ / / /� <br /> � /UeKI Xn �, anr � J'CSrden�� i /v bc bu,�// <br /> useoF euaoi , , / I HEREBY CERTIFY THAT I HAVE READ AIJD EXAMINED THIS AP- <br /> ! r <br /> �5,1�j_��.���HI/' JGS�dP � PLICAT;ONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> � �ec��/oEscm:*ir,n�ov FlOPEPrVISHOWNOELOWORHTTNGMFOt1RGOPIE51 PROVISIONSOFLAWSANOORDINANCESGOVERNINGTHISTYPE <br /> 7 �r� � J OFWORKWILL.BECOMPLETEDWITHWHETHERS9ECIFIEDHERE• <br /> I �or_L_C_e�oc�—oF e~��'f'� � IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ([�i,_,A/.+ 7.�'ia- a ^ O.(7 � ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCT�ON <br /> i OR THE PERFOPMANCE OF CONSTRUCTION. <br /> � SIGNAiUFE Of C��NTRAC OB AUTMORIZED AGENT DATE/�/f.O/c� <br /> � �/ O <br /> 1t X ` <br /> 1 <br /> •� PHOJECiPODFE9S ' � APPUCpNTSLIT�BUSINESSIIGENSENO. <br /> ; ��/3 �'u�u � • , , �. � .: <br /> PLUMBINd ' MECHANICAL � <br /> � NO, TYPE OF FI%TURE FEE NO. 7Y7E OF EOUIPMENT' � � � - FEE <br /> W.4TEf7CLOSET�TOILE IS AIRCOND.UNITS-H.P.EA. . <br /> B.4THTl1B IO REFRIGERATION UNITS-ii.P.EA' <br /> � S LAVATORY(H'ASH BASIN� U BOILERS-H.P.EA. � . ' ' — <br /> SHOWER GAS FIflED AC.UNITS-70NNAGE EA <br /> ] KITCHEN SINN 8 DISP. _ FORCE�AIR SYSTEMS-6.T.U. M EA. 3�Tp <br /> � OISHWASHER WALL HEATEHS-B.T.U. M <br /> LAUNDRViRAY UNITHEATEf`.5-B.T.U. M <br /> �� I CLOTHES WASHER EVAPORATIVECOOLERS <br /> � WATEP HEATER CLCTHES ORYERS _ � <br /> � URINA(. " �� ' � VENTILATION FAN � <br /> � �RINKING FOl1NTAIN _ RANGE HOOD . � <br /> FLOOP ORAIN AIR HANOLING 11NlT- C.F.M. <br /> VACUUM OREAKER9� S10VE <br /> � ROOFDRAINS-qAWLEAOERS METALFIPEPLACEB CHIMNEV % D <br /> � SINK SERVICE-BAR ETC. �J WOODSTOVE/FIREPLAC[INSERT <br /> 4 , — _ <br /> � � '� (���;SUB TOTAL SUB TOTAL 5 <br /> � .. . �.•.PERMIT S <br /> PERMIT 5 <br /> 't TJTAL FEE 3 TOTAL FEE <br /> i — <br /> i THIS PQRTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> i <br /> � FROHiSEiBRCN ' RE�RSETBeCN 910ESETBAGN VLANLHECNNUM9ER �UNCIIECNfEE <br /> y ZO 2 � / � I (�jL / D FEE55a — �ECEIPLNO. p.� _IC� <br /> A 10 O ''F7 <br /> ,1 USE20NE— r/ LOr�Di:/ sr� pESpN10 <br /> 1 fJ FEES VALUATION FEE <br /> s n dlQ <br /> � Nil IMq � <br /> iYPEOf�C-�ON/Si' x OCCUP�NCYGROUP NO.OFOWELLIN6UNI15 OO <br /> I ��l�I�I � ✓ I BUILDING S � S <br /> : 5¢E OF OLDO. / 3 NO.OF STONE9 MAX OGC.LOAO <br /> ,; ���/!n l Z/ n PLUMBING � <br /> �'6/ 0 �� — <br /> � MEGNANICRL <br /> i, fIRE SPRINNLERS REOUIRED ❑YES ❑ NO �� <br /> � OTNER <br /> PENRLTY <br /> �t �PPUCAl10N AGC.BY PUNS GIIECNED�Y APFR.FOR ISSUANCE OY D� <br /> �! /l�I-//, . �� � . 1�TA� <br /> � �� ' <br /> j � �'�1���( Su�C-`r ���� <br /> 7 �� �-t.���— <br /> t <br />