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APPLICATION FOR ��e <br /> tM EvrryrMn C�,N ST R U CT I O N <br /> an or <br /> ever�tt PERMIT <br /> DEPT.OF COMMUNITV DEVELOPMENT SERVICE$ <br /> CITY HALL 259-8715 <br /> eveaeri.wn9aioi ��OMBINATION ❑ BUILDING ❑MECHANICAL ❑PIUMBING PERMIT N <br /> �i�� Z�p VHONE <br /> OKNf R M�II nDONf SS <br /> �C°_P,T "ST� d b ';I'� P Q ''ox 503�e `v�"- '' � 'asi�. `?o i0u ^r3-��41 <br /> ,� ^ ^^. 'C 1 ZIP PNOHE <br /> n0.CHIifCT OR U[$IG`�l0. MAII ApDPES$ <br /> ogo�C G54-2�00 <br /> ;�r:':,;r:L-, it:C. 1272 Statc Ave.� ;.:arysvill.e ';1as}1• - VNOHE LIC[MSf1 <br /> �[N{i�ICONIR�CIOR M�IIADDRlSS ❑TY 21V <br /> ;:E7LA;:D CC;'ST'.-��T1G', li'C. 33G2 Iiill St.� Evere�t Clash. 223-�1-5:(';;-iI 237JE3 <br /> AIICN�M1IUICOH�A����A MnII�ODPl55 <br /> ❑IY LIP PHON[ llC[NSl/ <br /> PIUMPHC COv10.�CtON <br /> Mnll�DOR.55 CI1Y 21V FHONI UC[NSE/ <br /> CU53 Oi wORR '�7 <br /> ❑NEW ❑�DDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE /,y�$IGN ❑GARAGE BUILDIIIG R:IOCATION <br /> \'nlU�llOrv Oi N'ORR <br /> y 57i2�('i� <br /> oiscaiet woaa ^ <br /> 2 ea. illuninated roof�op si�n di>Pla;�s� 1 c:a. �` ]: 14' 1 e�. 4' :, 2�' �innlc :ace ,_ <br /> rvoroseousi or euuoiNe I HEREBY CERTIFY iHAT I H�VE READ AND E%AMINED THIS AP- <br /> � ,. PLICA710N AND KNON'THE SAME TO BE TRUE AND CORRECf ALL <br /> B��ll carpet S3I.C5, PROVISIONS OF UWS AND ORDINAWCES GOVERNING THIS TYPE <br /> IIGAtDISCPIP110'�Of PROPkPiY�SHOWNAfION'ORAII�(1110URCOPIF51 OF WORK WILL BE COMPLIED WITN WHETHER SPECIRED 4EREIN <br /> �p���PIOCK���� OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOUL LMN REGUUTING CONSTRUCTION <br /> OR THE PERFORMA�C! OF CONSTRUCTION. <br /> SIGNATURE OF CONTR(�CiJR O�TNORr�AGkN7 DATE <br /> we.noxiss ' ':1,20i1. °�2`.?�: X /� � / �L�/�� (/ :.���i' '/;/ <br /> ��16 P�ir,e St.� �ver.etc� <br /> MEC EN1Ul <br /> PLUMBING FEE <br /> TYPE OF fl%TURf (CE 6. TYPE OF EQUIPMENT <br /> NO. / AIRCONO V�ITS-HP EA <br /> N'ATIR<<OSL717011C7� <br /> RHRIGlF4TIJNUN115-HP U <br /> UA7MiUB <br /> POrtIkS-HP U <br /> UVATORV IWA51/BASIN) <br /> ' WS I IR[D�C UNI75-10NNAGE EA <br /> SMONIR <br /> �pq��D�IR5157fM5-BTU MEA <br /> NI7CHlN SINK 6 n�SP <br /> NALlMEA7fR5-EiT� M <br /> pb\VASHf N <br /> �NIiHiAiLRS-117U M <br /> UUhDRv iRAV <br /> kb�P00.A71V1 COOLEftS <br /> CL07NI5 WASHF0. CIO1Mf5 D0.VIB5 <br /> N�7lR NfATLR <br /> Vf N11L1110N{AN <br /> UNINAI RANGF IIOOD <br /> DRINKING fOUNTAIN <br /> AIR NM�I I!.G UNI7- C F M <br /> IIOOR DHAIN $IOYI <br /> V�CUUN ORF ARI RS � <br /> Mf iAl I�Nf PUU 6(NIMNEY <br /> � k00� DHAINS-RAINLEADLRS <br /> SINK 6lNVlCf-OAR L7C 1 <br /> SU�TOTAI 1 , <br /> SU!TOT�I. �[RMIT t <br /> f <br /> �[IIMIT TOTAI fFE f . <br /> TOTAIfLE � <br /> hIAN CMFCK FEE <br /> SIDf YAR05[iOAfK 51N[[1 5[TflACK NUR Y�AO SElOACK �lANO1CCK NUMl1(R `EE RFCEIPT NO. <br /> USf ZONL LOT ARU YAUNT 51T[ ��fs VAWHTION tFE <br /> GrES L'NO <br /> IYPE OF CON51 OCNPANCY GROUP NO Of DWLLUNG UNI75 . <br /> d�����N� 'S7ZZ• '"L1 csU <br /> S�Z[Of BLOG NO Of STORIES M.\% OCC IOAD <br /> Pl VMNING <br /> RNFZONE 6A5[MFNT HIDNOOMS RIQUTAf�OKlf0.5 MfCMANIUL <br /> �YIS CNO <br /> �M�OV�lS �T DA7L OTHEN <br /> UAC <br /> 1 [NVINONMENTAIGM[CKlIST PINALTY SFC 70JIa) <br /> 1 NUIlO1vG PLANS TOUI <br /> J fIN11/YDMANT <br /> �[tMIT VAIIDATION <br /> � {INFPROIfCTION5Y51FM µ���(NPROPfRLYVALID�ifU11NTH155PAClITNI515Y0URPFRMIT <br /> 5 GRAOINGr�%(:AVATION6ClfARINGIGNUAflING <br /> 6 DNAINAGF _ ��- 1 <br /> _ . � ' / ' ��� /1 <br /> 7 ENVIRONM[NMl IMPACT 57ATEMENT � _ . � � <br /> E MUtiHO�STRICI <br /> nrPlu.�l¢�vnCC Nr PLAN6GRCKF,pOY <br /> APPB IOR ISSWNCt AY <br /> �� _, :,�;�' f ��(5 Cr2t�7�fc�a �� <br />