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,ME,w,n,� . .PPLICA►TI:�N FO.. P��,�„ <br /> ��^�°° CONSTRUCTION <br /> �verett PERMIT ��+ <br /> BUILO�NG DEPARTMENT <br /> 259-a745 TO BE COMPLETED IN INK • PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION ❑ BUILi:ING ❑ MECHANICAL ❑ PLUINB!t�lG ❑ SIGN <br /> OWNER MAI��ODRES$ CIiY 21P p��pq(.—� <br /> V11��;r�sv,v c'�,,sF .Dac i�C, £ U.�� Dp i w�aw C�w-�,K�m �s (��2. =c; 5 7 � <br /> ♦lIC�IiICL10H�E51GNEN M�Ilq00PE5S Lltt 2iP Pr�ONE <br /> �?3�1 DF`Q�3�b�1 lJ e g�5 Y! �✓z.r.,e,ff' <br /> GtNEH ICUNIfUC10N MAILApOf1E55 CIiY 21P 19101�( t�CLNtiI � <br /> y�?�f-r-�su,J Cr���f -D'C , i5� F V�=� D�l ls,�.e C�+-r,w-.�o -L� r'�J�7tELT/I34/1 <br /> MI.GUNI(�ICONiRALTtl� MML�pORESS CIIY 21P PIIONF IiCt�itil • <br /> R� ti�rw�f �,� r,t z�� �, � <br /> VIUMBMti[ONIHA�;pN MAllA00RE55 CII. ZiP PUON[ LICl1,1.�— <br /> ! <br /> ��� � ,,; °,, ��a--r Y s� �»6�� <br /> cuss ui wonK <br /> LYNEW ADDITION ALTER:.TION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FpPL.INSERT ❑ BUILDING RELOCATIO�! <br /> VPl U��bON O�WOnRM�COS�01"AIAIERIALS PL US LRBORI I <br /> �[.E.�� FK�I I <br /> U SCRtliL WUfIN <br /> �(�dzecJ I��e-5 _ <br /> us�.or uunoiac <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAID[SCRiPiIONOFPROPENTY15110WNBElOWORRITALNFOUNGOPIES� pROVISIONSOFLAWSANDOFDINANCESGOVERNINGTHISTYPE <br /> �J �� � OFWORKWILLBECOMPLETEDWITHWHETHERSPECI�IEDHERE� <br /> ior�5 aioc�_or il� IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIO:JS OF <br /> W.e �'�- Cr[.t�.,� ANY OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFURMANCE Of CONSTRUCTION. <br /> SIGNATURE OF f.pNTRACTOR OR AOTMORI2E�AGENI OATE � <br /> - -G(��-��=.-� 3�� <br /> PBOJCClApI1fIE55 APPIIC T CITYBI151NESSlICENSENO <br /> , cr Gjfbl /� �� �' . ' � <br /> y�)� �, �, 6 �. . <br /> PLUMBING MECHANICAL <br /> _NO. TYPE OF FI%TUNE FEE NO. TYPE OP EOIIIPMENT _ FEE <br /> WAII'll CI/l•lfT IT(111 f q i AIR f.l1Nf1 IINITF -II P 1.� ---- ----" I—�— <br /> BAIHTUB REFRIGERATiON 11NlT5—M.P.EA. � <br /> LAVATORY�WASM BASIN� BOILERS—H.P.EA. _ � <br /> SHOWER GAS FIPED AC.UNITS—TONNAGE EA __ __ _ <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASMER WALLHEATERS—B.T.LL M <br /> LAUN�RYTR4Y UNITHEATERS—B.T.U. M <br /> CLOTHES WPSHER EVAPORATIVECOOLERS <br /> WATER HEA7ER CLOTHES DRYERS <br /> URINAL VENTILATION FAN ___ _ _ <br /> ORINKING FOUNTAIN RANGE HOOD <br /> _ Fi00R�RAIIV Alq HANDLING UNIT— C F.M. __ ___ <br /> �_ 'VACUUM ONEAKERS STOVE _ __ <br /> _ ROOF ORAINS—FAINLEADERS METAL FIREPLACE 8 CHIMNEY _ _____ _ <br /> SINK�SERVICE—BAR.'=TC �'d00DSTOVE/FIREPLACEINSERT ___ <br /> SUB TOTAL Sl1B TOTAL _ S ___ <br /> PEHMIT S PERMIT S <br /> _.— —__ '_'.-- —_...___... <br /> TOTALFEE S TOTALFE£ _ S __ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �ROKSSFIO�CM1 REPRS[iBACH SIOESETBACK PLANGNECKNlIM1IBER �'lR�1CUELnF[E <br /> �/ 7/� '7a� FEE L__ ..[.` R[f.LiPl NC <br /> �F•, /cF J C�G.� <br /> �ISttON[ LOiF�ER yqCRNT511E ' <br /> FEES VALIIATION iEE <br /> �YES �NO --'-----"- <br /> h'i'COIf,pN51 'OCNPnNCYGf10UP NOOFUWELLINGUNIiS <br /> BWLDING 3 <br /> ]i1G G�Bi I1G � NO Of STOlilES MRX.OLG.lOAO — ---" <br /> PLLIMBING _ _ I I� <br /> AIECNANICAL --1--_ _ I <br /> FIRE SPqINKLERS REOUIRED ❑ YES ❑ NO i <br /> OT11ER <br /> PENALTY -- -- , I � <br /> :YVUG:bON:Cf. BY PLANSLUECNE��Y APPR FORiSSUANGEBY ' ' <br /> ; TOT�L 1 <br /> ��/(/� �—.�_ __I. . <br /> V —' _ <br />