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,�, <br /> � APPLICATION fr�R. everen <br /> '"'E"'°"'" CONSTRU�TION �i <br /> cin oF <br /> �v�erett PERMIT <br /> TO BE COMPLETED !N BLACK INK— PLEASE PRINT <br /> BUILDIIJG DEPT. � <br /> 259-8T45 [J COMBINATION ❑ 6UILUING ❑ MECHANICAL �PLUMi91�JG ❑ SIGN <br /> OWNER MMI�DORESS CrtV LP PnON[ <br /> �� �/Q-s� A'+g - ' �,G�r.n-�c .. ��%i� <br /> ♦RCF�TEG ROES�ONF ` " MM�A�ORE55 Cin' Zi �'MO��E <br /> / <br /> OENEPAL.!HR�ClC1 MA�ApOHE55 G'�Y LV• PUOrvf UCtnSE • <br /> ` � �� �r�L��� i �-{I I ���-/Qy� <br /> ME N A CUNiMCTOq MAIL�OORE55 Cilr ZIP ��10nE '��V�iP'JCY/�/� <br /> ��ti _—���fff �' /�l�islr-Il`.�S�v S�'� ,l�.d- �l�'/�if x4�//� ' <br /> P�BI � ON �CTOfl � ,/ MAI�ADD� LI1V 21P CIIONE IIGENSE• <br /> 1� <br /> CLASS�F WORK <br /> ❑ NEW DITION ALTERATION ❑ REPAIP ❑ DEM110LI710N ❑ WOODSTOVE/FRPL.INSERT ❑ E'UILDING fiELOCt.iION <br /> WLUATION OF WORN�CO51 OF M�IERIAL9 PWSL�OORI Z <br /> O <br /> --I <br /> t.. <br /> '_'_ . n <br /> DESGRI9E WOPN �Tl <br /> useeveuaoiNe I NEREBY GtRi�IFY THAT I HAVE READ AND EXAMINE�THIS AP- <br /> .+ .. <br /> PLIC4TIONANDKNOWTHESAMET08ETRUEANDCORRECT.AIL � T <br /> LEOALOESCR�PTIONOFPqOPEFtt�SHOWVBELOWORNiTAGNFOIIftGOP�F51 PROVISIONSOFLAWS�NJORDINANCESGOVERNINGTHISTYPE � --� <br /> OF WORK WILL BE COMPLE7ED WITH WHETHEfi SPECIFIED 11ERE• �' _ <br /> m <br /> ior�n�oc�—oF IN OR NOT.THE GRANTING UF A PERM1111 �OES NOT PFiESUME TO � o <br /> GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISiOD15 O� m o <br /> ANYOTHERSTATEORLOCALLAWREGULATINGCONSiRUCTION � � <br /> ' OR THE PERFORMANCE OF CONSTRUC'I'ION. o m <br /> $IGNAIUqEOFCONIRAQORORAUT11pRILED/GENi OAIE --� Z <br /> S --1 <br /> X � , / m <br /> .. <br /> q Z <br /> ' C <br /> PRO�CTf�OAESS /�� �PPLICA �SC�j US�NCSSliCi9 CNO� C� �� <br /> � ��� '� � C_p ., �--� <br /> 'C' <br /> � � � <br /> LUMBIHO MECHANICAL ____ _ T <br /> O .'� <br /> N0. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT _ FEr_ T 3 <br /> AIR COND. UNI IS-H_P.EA. --I m <br /> WATEF ClOSET�TOILEn "-" S <br /> BATHTUB REFRIGEA�TION UIJITS-N.P. EA _.___ ____ __ �q r+ <br /> - N <br /> LAV4TORYIWASN BASINI BOILEPS-H.P. f.A __'_"'__ _ p <br /> SHOWER GAS FIRGO A.C.UNITS-TONNAGE EA __ n m <br /> KITCHEN SINK 8 DISP. FORCEU A�A SVSTEMS-0 T U M f:f__ 3 N <br /> DISHWP.SHEF WAIL HEATERS-B_7 LL M ____�__ m � <br /> LAUNDFViRAY _ UNILHEATERS-D.i�U. M _ --Im <br /> CLOTHES WASHEF EVAPOPATIVE COOLERS � D <br /> WATER HEAiER CIniHESDRVERS _ ___ � <br /> URINAL VENTILATION FAN =. <br /> DRINKING FOUNTAIN RnNGE HO00__ _ — n <br /> z <br /> FLOOR DFIAIN __ A�R IIAN�I ING 11NlT-�_ C F.IA. __ _ <br /> H <br /> $TOVE _ <br /> VACUUM BREAKERS — ��-- ---- -- � <br /> ROOF DRAINS-RAtNLEADERS MEtAL FIHE�PLAGC 8 C�uhINEv _ ti� <br /> SINK SERVICE-Bl.R,ETC. WOOOSIOVE/FIRCPLACE 1115ERT _ __ -� <br /> G <br /> — � <br /> � <br /> _ f": <br /> m <br /> SUBTOTAL SUB TOTAL 5 <br /> PERMIT S PENMIT _ s <br /> TOTAL FEE S .___ TOTAL FEE ____ 5 __ _ <br /> TfiIS PORTION TO BE COMPLETED BY BUILGING DEPT. PERSONNEL <br /> FpONlSETBAGM AEARSEiBRCR SID�SETOPCR PLAHG���-CRNIIM1�RCfi ^LANG��EGHf[E <br /> ree r�r.eeirr��o <br /> USE IONE LOT AHE� yqCAM SITE KEES VALU�TION iEE <br /> ❑YES ONO <br /> ttPEOFGONSt. OCGUPANCYGROUP NO�OFDW[LLIHGUrvIiS <br /> �UIL�ING s I <br /> 5¢E OF BLOG NO.OF S1URiE5 MA%.OCC.LOAD � <br /> PLUTADIHG <br /> MECIIANICAL <br /> FIRE SPRINKLERS RE�UIqED ❑ VES ❑ NO OTNE9 — — __ 1 <br /> I <br /> pENALiY � <br /> APGLIG�TIONACC BY PL�NS CMEGMED BY hPPR fOR�SSURNCE BV -- — I � <br /> TOTAL <br /> '___ _— -__.�_ � <br /> ____ I <br /> �� J <br /> I <br /> 1 <br />