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'APPLICATION FOA <br />EreTpreen <br />YOF <br />CONSTRUCTION <br />,Iverett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />IILDING DEPT. <br />v8745 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ <br />PLUMBING Cl SIGN <br />Inn <br />IAAIL ADDRESS CITY ZIP <br />'�aa 140 EV . 0:3 <br />PHONE <br />-�i70� <br />�in.l-T:JII <br />QST Er_F-,-r <br />.d5-� <br />rREW OR OLSIGNLn <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />(RAL CONTACTOR , <br />MAIL ADDRESS C CRY ^ ZIP <br />I)W �YT-)_7� <br />PHONE LICENSE <br />)1'llll'x •rl I.IN I7F1> <br />I£;U 3:j i qq �JLIITEU-YhN[CCK701 <br />NANICAL CONTRACTOR <br />MAIL ADDRESS LITY ZIP <br />PHONE LICENSE• <br />,IBINGCONInACTOn <br />MAIL ADDRESS cow ZIP <br />PHONE LICENSE• <br />:S OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT Cl BUILDING RELOCATION <br />NATION Or WORN (COST OF MATERIALS PLUS LABOR) <br />%l W )pC <br />aRIBE WORK <br />T -, n <br />r ;t ­Ii <br />'IF BUILDING 1 <br />'/lP- IL F E:" '7/OI_Nr�d3 <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. /Y <br />SIGNATURE C%OONNTRACTOR RAU�T14 /R IIIIDAGENT(VII/T DAIEIO/G/FS-i <br />lJ L' V 1 i "G`�T%C�l.'I <br />It. DESCnHPTIDN or PRoPEnTY1sHowN BELOW on ATTACH FOUR COPIES) <br />_RLOCK_OF <br />'CCTri C>l .3-acxC,C� <br />IFCT ADDRESS <br />I;II �')CAIIUI'F�T _UEnr-i <br />APPL.^ANTS CITY BUSINESS LICENSE FIG <br />IMBING <br />MECHANICAL <br />NO. TYPE OF ECUIPMENT FEE <br />O. <br />TYPE OF FIXTURE <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />_ <br />LAWTORY(WASH BASIN) <br />_ <br />BOILERS-M.P. EA <br />_ <br />SITOWER <br />GAS F ED AC. UNITS -TONNAGE EA <br />F ITCHFIRSINK A DISP. <br />FORCE( IRSYSTEMS-B.TU. MEA, <br />DISHWASAER <br />WALL HEAT RS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATER-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE C60LERS <br />WATER HEATER <br />_ <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN \ <br />_ <br />DRINKING FOUNTAIN ` <br />RANGE HOOD <br />_ <br />FLOOR DRAIN \ <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />.'TOVE <br />ROOF DRAINS-RAINLEADERS �� <br />METAL FIREPLACE 8 CHIMNEY \ <br />_ <br />_ <br />SINK ISERVICE-BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUB TOTAL <br />SUBTOTAL 8 <br />PERMIT S <br />PERMIT S <br />TOTALFEE s <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />ETBACr, <br />REAR SETBACK <br />ZO <br />Zp <br />IE <br />LOT AREA <br />R-I <br />/9 5 Sf <br />COr1ET� <br />OCCUPANCY GROUP <br />BLDG <br />NO. or sionlEs <br />)x3` <br />CADUNACC nY PLANSCHECCKEDDBBY <br />4r <br />VACANT SITE <br />OYES XING <br />- <br />NO. OF DWELLING UNITS <br />BUILDING <br />MAX. OCC. LOAD <br />�.. <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />FEE3a3 necE Ifn J <br />�� d <br />VALUATION FEE <br />s <br />