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p of CONSTRUCTIONS weverett PERMIT <br />BUILCING DEPARTMENT <br />259•R745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION CTBUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />01 IT MAIL ADDRESS Cltt ZIP PHONE <br />I/MG e4oyH67DoQE uJY Se�rrtE 98/99 2ctS'Zyoo <br />ARCHITECT OR DESIGNER MAIL DD14ESS CITY ZIP <br />/ PHONE <br />77 Al <br />GENERAL CnNIu¢lno ................ _ <br />MI <br />ggod <br />CHANIGI CO InACTOq <br />MAIL ApDRE55 <br />CITY <br />JA _ <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBINGCONTRACIOA <br />MAIL ADORES$ <br />CITY <br />I "I Or wno- <br />ZIP <br />_ <br />PHONE <br />IICEN51 <br />❑ NEW ❑ ADDITION LJ/ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT Cl BUILDING RELOCA71ON <br />1AL UABON Or WORK ICOST OF MATERIALS PLUS LABOR) <br />$y-aoe) <br />usI o ew[DINr, � <br />I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP, <br />PLICATION AND KNOWTHE SAME TO BE TRUE ANDCORRECT. ALL <br />AAL DESCRIPTION Ir nROPF9ry I$ <br />IIHOWN gElORAiIACH FOUR COPIES) <br />PROVISIONSOF LAWSAND ORMNANCES GOVERNING THIS TYPE <br />IOT—SLOCK__or <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF 10 <br />GIVE AUTIIOHITY 10 VIOLATE OR CANCEL THE PROVISIONS OF <br />-t/ <br />ANYOTHERSTATEOR LOCAL _AW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />I'ROJECT ADDRESS <br />APPLICANT'S CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />WATER CLOSET ITOILET) <br />_ <br />AIR CONED. UNITS—P I. EA <br />FEE <br />BATH'. UB <br />REFRIGERATION UNITS—H. P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H P.EA. <br />— <br />SHOWER <br />_ <br />_ <br />GAS FIRED AC. UNITS —TONNAGE EA. <br />_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNORYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WRIER HEATER <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE—BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />— <br />SUBTOTAL f <br />-- <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'U LI 10AlK <br />NEAR SETBACK <br />L <br />N /' • <br />SIDE SETBACK <br />PLAN C 14ECK NUMBS. [ <br />6 r <br />FEES <br />,cY�- PLAN <br />LE L�V <br />VALUATION <br />CUCCN lEE <br />NECEIPI NO C� �� Z <br />FEE <br />.'LINT <br />(J <br />f+- <br />TOT ARfA <br />r <br />�A •n. <br />VACANT SITE <br />OYE$ceRIO <br />n1 CONNS`1 <br />N <br />OCCUPANCY CHOMP <br />g-ES <br />NO OF DWELLING UNITS <br />Q <br />BUILDING <br />S <br />50 <br />of mRcpG <br />N •U- <br />NO O! $IOIR[$ <br />1 <br />MA%OCC LOAD <br />PLUMBING <br />SPRINKLERS REQUIRED OYES D NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />:AIION A.C/E.; BY <br />M,IY\ A <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />— <br />�s <br />