Laserfiche WebLink
.- <br />IA. EwFfnmiR <br />APPLICATION 1`06) <br />Ceverett ITY OF <br />CONPERMITrIONe <br />BUILDING DEPARTMENT <br />259.6745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION <br />❑ BUILDING ❑ MECHANICAL <br />C9 OLUMBING <br />❑ SIGN <br />DWIIE <br />M11L ADDRESS CNY ZIP <br />PHONE <br />- • <br />1RCIIITECi ORR <br />�rJcJE.�/ <br />2��I—/7�� <br />DE DESIGNER%� <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />ANERALCOIITRACIOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE 1 <br />M <br />...o.....mC-Lwnnmu VH MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />• <br />LICENSE <br />PLUMBING CONIRAROR MAIL ADDRESS <br />CITY <br />21P <br />zoo A,c <br />CLASS Of WORK J <br />f) C�:j 1,.; <br />S K�'Fo <br />PHONE <br />-I <br />�cC <br />Ei <br />L] l W/c <br />%L3 <br />❑ NEW ❑ ADDITION C3" ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPLANSERT <br />❑ <br />lALUA110N OF WORK (COST OF MAILRIALS PLUS LABORI <br />BUILDING <br />RELOCATION , <br />/CC';I <br />14'IA 1. I /. <br />USEBUILDING I <br />S / / a <br />LEGAL DESCRIPTION -(SHOW <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOWTHE SAME TO <br />O PROPER GELOW OR ATTACH FOUR COPIES) <br />BE TRUE AND CORRECT. ALL <br />PROVISIONS <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LOT— BLOCK _OF_' <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME <br />TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE <br />PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON TRACTOR OR AUTHORIZED AGENT DATE <br />---�—� <br />PROJECT ADDRESS <br />APPLICAN CITYBUS ESSLICENSENO. <br />PLUMBING <br />MECHANICAL <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />OSET (TOILET) <br />AIR COND. UNITS-H. P. EA. <br />FEE <br />REFRIGERATION UNITS-H.P. EA <br />li <br />IWASH BASIN) <br />BOILERS-H.P. EA <br />GAS FIRED AC. UNITS -TONNAGE EAINK& <br />DISP. <br />FORCED AIR SYSTEMS-B.T.U. MEAER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />_ <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADEP.S <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <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 />I RONT SETBACK RLAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />IISE LONE LOT AREA <br />VACANT &1E OYES ONO FEES VALUATION FEE <br />IYPEOF CONST OCCUPANCY GROUP NO. OF DWELLING UNITS <br />STORIES I MAX. OCC. LOAD <br />ACC BY <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />