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- �. <br /> APPLICAI .JN FOR CONSTRUt, �'ION <br /> PERMIT <br /> tbe Everyrpen <br /> CITY OF <br /> �ever�it �"e`e" <br /> BUILDING DEPARTMENT e <br /> 259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> OWNEN MAIIAp�qE55 CIiV ZIP PHONE �' <br /> `�n��it� L. L�l i� g �.sY... �CI7 ( eVe .��� �i.� �i.h�. 9�2v3 �iC/7-OFJLS <br /> �eN�Ni a MAILAO�flESS G�TY ZiP PHONE <br /> �T��q�G,eJ�P��O sn MAII�OCHESS ��Ty zip <br /> I 1• . ('� 1 1 �I d ' /� O C (� ' PMONE <br /> OENEMLCJNTii�CTOR e bYV�LNQY /G .�_C "" � pr G �� �2^OT/�S U'LfjCAL/ '�S�c <br /> / � MAIL�OJFESS CITY / 21P . PHJNE LILENSE• <br /> (A/ GGi '} �DG^fiH.� �/e(/ ?I - /Z7e�� Q/ � G/i.c� -sr{�i t .j 9�7S�Jf <br /> ` MELHAIIWLCONTRACTOR MAILA�DRESS CITY 21P FHONE LICENSE• <br /> PIUMBINGCONTMCTOP MqLALORE55 GITY ZIP PHONE �LICENSE• � <br /> /�euw �.�. �/ILw � 9/ 3�/> 's'�ws/_5�• Gv rw ��lia Q�i ZG 3 ZS`B <br /> GLASS OF WORK -5�i rG � <br /> �NEW ❑ ADOITION ❑ ALTEflATION ❑ REPAIR ❑ DEMOLITION ❑ WUODSTOVEJFRPL INSERT CI BUILDING RELOCATION <br /> TENMITIMPflOVEMENTORINiERIOflRE ODELOM1IY GONTRCTPER30NANDPMONENO. <br /> CANTMCT PNICE OF WOflK o <br /> OESCRIBE WORNANO SOUME FOOTAG INV D �� �� <br /> �d��' /�nn�;� Z S �.�-. �. <br /> PROPJSED USE OF BUIL�ING�-�� <br /> / � /� I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br /> S/pt�i FGw�i� Q�riF�L..G� 7Clwid-5 KNOWTHESAMETOBETRUEANDCOPRECT.ALLPROVISICNSOFLAWSAND � <br /> '.EOALOESCIPTIONOFPpOPEB �SNWINBELOWOR�TtACHFOURCOPIES) ORDINANCESGOVERNINGTHISTYPEOFWORKWILLBECCMPLETF.UVlIfH <br /> �+ WHETFIER SPECIFIEO HEREIN OR NOT.THE GRANTING OFA PERMIT OOES NOT <br /> �or BiocK pF � / PRESUMETOGIVEAUTHORITYTOVIOLATEORCANCELTHEPROVISIONSOF <br /> ANV OTH ER STATE OR LOCAL LAW qEGULATING CONSTRUCTION CiR TH E PER• <br /> FORMANC E OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1B27 RGW AND <br /> 2962C0 WAG <br /> SIGNA'UREOFGO.lTPALTOflORAUTMOR2EDAGENT D�TE <br /> `� lDl'� � �� X _ � ' <br /> � L / /� � <br /> PeOJECTAD E59 s /- �(J^ �/ � I� <br /> �/)L� �-1-i-� ���� �1 �PPLIGANiSLiTY6U5iy ,.5LICENSENO.�Np8U51NES5NAME F <br /> �t (J J <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURp OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEq CLOSET(TOILEn !VC-lVHNOLG UNITS-H.P. <br /> I BATHTUB FOFlCED AIH SYSTEMS-6T.U. M EA <br /> LAVATOHY(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYF.RS <br /> KITCHEN S�NK 8 DISP. VENTILATION FAN <br /> DISHWP.SHER P.ANGE H�JOD ' <br /> LAUNDPY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CF'.IMNEY � <br /> DRINK�N6 F7UNTAIN FIREPLACE INS[RT � <br /> FLOOR DRAIN HEAT PUMP `I <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC) <br /> SUBTOTAI E SUBTOTAL 5 <br /> PERMIT S PERMIT $ <br /> TOTAL FEE $ TOTAL FEE S <br /> FqONT5e8GLl( qEARSEfBACK SI�ESEfBIIGN PIANCH NNUMBEfln'n FE qECEIPiNO. II <br /> � � � � ���l -! �� o�L� <br /> u5E2oNE LpTAflEA v TSrtE FEES VAIUATION FEE i <br /> �r� ���� res oNo <br /> � N <br /> YPEOF�pN4T. OCCUPANCY ROUP NO.OFOWELLINGUNIIS BUILDING �( / ,� <br /> aiow�e«�c,un� y^-N �j <br /> 1�.'I � PLUMBING <br /> A2E OF BLOG NO OF STOfl1E5 BSMT. OCG LO�� <br /> �/_�� S� ij N �� MECHANICAL <br /> K/ C�- <br /> HEIGHiLIMITAT10N OTHER ,�� � ��� <br /> �5� <br /> iqESPPINK�EflS REOUIREO ❑vES NO STATE BUILDING SURCHARGE <br /> STATE ENERGV SURCHARGE � � � � <br /> >PLICATION�GGBY PUNSAVPRg� � <br /> � � PUBLIC WORKS <br /> / TO7AL l�?� ��- <br />