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,. . . . . _. � ._. _. ,. . ... . . . . ... � _ . . . . .... '..t ._. :,r�: ._. . . . . . .. . .,. � . . . . :t:': ...:.:�i11YIte.:��... .�; <br /> \ <br /> G E�,�,�� ;=.�PPLICATION FOI.� ' ���.�„ <br /> CONSTRUCTION e <br /> evcrett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPL=TED IN INK- PLE.4SE PRINT <br /> ❑ OEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER M�IL�DORE55 Cltt ZIV PMONE <br /> _ m.� 3 ` S �w7�` �� 0 33 - I? <br /> •RLMITECTO SIGNEN MAIL�OOPE55 C�iY ZIP PNONE <br /> GENER�L CONTR�CTOP M�It�O�RE55 Gltt IIP vHONE uCENSE• <br /> .��,s��'� SS2S SR9�2 .�.�i.�-a�.a- 9'62Sg 33Y-73/G L�LI'�/.4L�dQ9DH <br /> ME �Ni'�l LONTR�CTOH MALL�ppPE55 C�TY Z�P PNONE LICENSE• <br /> PLUMBINGCONTflAGTOR MAIL��OFE55 GITY 21P PIIONE LIGENSE• <br /> CL�SSOf WORN <br /> ❑ NEW ❑ ADOITION ❑ ALTERATION � REPAIR ❑ DEMOLITtON ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> W LO�TION OF WOFNn�CO,ST O�M�TEFULS PW 5 L�BORI <br /> � � / v v <br /> DESCRIBE�VO K e* . <br /> � <br /> � USE OF ULLOiN � <br /> . I HEREBY CERTIFY THAT I HAV READ AND E AM ED THIS AP• <br /> PLICATION AND KNO NTHE SAME TO BETRUEAND CORRECT.ALL <br /> ' �ca��oes PTiONOFPp RTYISMOWNB OWONAITALNFOURC i¢si PROVISIONSOFLAWSANDORDINANCESGOVEFNINGTHISTYPE <br /> � aJ ' ' OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> , ioi�I�e�oc�os ' INORNOT,THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE UR CANCEL THE PROVISIONS OF <br /> ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIGNATUPE DF CONTH�CTOR OR AUTMORIZED AGENT PATE <br /> X -'�9 <br /> PROJEGT�DDRESS �PPLIG�NiS GITY BUSINE55 IiCENSE NO <br /> s�s — <br /> PLUMBIN6 � MECHANICAL <br /> NO. TYPE OF FIl(TURE OR ITEM fEE NO. TYPE OF EOUIPMENT FE! <br /> WATER CLOSET(TOILET) NC—AmNOLG UNITS—N.P. <br /> BATHTUB REFRIGER�TION UNITS—H P.EA. <br /> UVATORV(WASH BASIN� BOILERS—B.T.0/H.P. <br /> $HOWER G�S FIPED A�C.UNITS—B.T.U. <br /> NITCHEN$INK 6 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASMER WALLMEATERS—B.T.U. M <br />� LAUNDRY TRAV UNIT HEATERS—B.T.U. M <br /> CLOTHES W�SHER EVAPORATIVE COOLERS <br /> URINAL CLOTHES DRYERS <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOON ORAIN RAN6E HOOD <br /> BACKfLOW PREVENTERS WATER HEATER <br /> ROOF DRAINS—RAINLEADERS WOOD STOVE <br /> - SINK�SERVICE—BI1R.ETC� METAL FIREPUCE d CMIMNEY <br /> FIREPUCE INSERT <br /> HEAT PUMP <br /> . GAS PIP�NO <br /> E%HAUSTFAN <br /> 'BUOTOTAL f SUSTOTAL <br /> � PERMIT f PlRMIT <br /> TOTALFEE f TOTALFlE <br /> �RONiSETB�CK RE�N SETB�GK SIOE SETBACN <br /> ' PLAN I:MECK NUMBER FEE RECEIPT NO. <br /> use zoHe l0T AREA yAC�NT SIIE FEES VALUATION FEE <br /> OYES �NO <br /> BUILOING S <br /> ttPEOFCONST OCCIIP�NGYGNOUP NOOFOWEILINGIINITS <br /> � f'LUMBING <br /> 512E OF BLOG NO OF SiORIES MA% OGC IO�D MECHANICAL <br /> OTHER <br /> FIRE SPRINKLEflS REQUIRED ❑VES ❑ NO STATE BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> RVP�ILRf10N�Cf. BY PUNSL'REGKEDBY �PPRi0RI55U�NGEBV PUBLICWORKS <br /> TOTAL <br /> PROPERTY OWNERSARE RESPONSIBLE FOR DETERMININO ALL <br /> PROPERTV LINE LOCATIONS AND RELATED EASEMENT9. <br />