Laserfiche WebLink
■ <br /> In�Evupiesri `. �PPLICAT19fV FO._���� <br /> ""°F CONP RM�YfON eV� <br /> evere�tt <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ pLUMBING ❑ SIC,N <br /> �W EA MAILA00liE55 <br /> PIIONE <br /> � ��11��nE�l�t�l,rc: ►�1�- d� �'1 �Z�� �� � sci-� ���� <br /> AG�II;iECIORpE NER ���y Z" <br /> f4�Ot1L <br /> GENEflALCONTF.FCfOfl MAILqppRE55 Cltt 21P PIiONE <br /> uCEI1SE• <br /> � tn [�PtY, �l�i 7 � y rtly'�IE dll=���l. G/C��2 � _L S�LS�/� fCe� - � ' 15,��� <br /> MEb11ANICAI.CONiflAQ� q MM1ILADORE55 CITY ZIP FllOfl[ <br /> LIL[115[• <br /> PWAIBINGCONTPPCiOfl AI�ILApDRB55 CIIY ZIP VIIOIIE <br /> UCENSE• <br /> CIASS OP WOflK <br /> ,�I NEW L7 ADOITION ❑ ALTERATION ❑ REPAIF: ❑ DEMOLITION C WOODSTOVE/FRPL.INSERT ❑ BUILDING flELOCATION <br /> WLluiIONOF WORN ICOSi OF RIATERIALS PLUS LABOR� <br /> ���, , ., ��, S�,GY�'��= <br /> oescnme�vor K <br /> c G✓ l� _ • '���e <br /> USE OF 91111�ING <br /> V' (,,( S � I HEREBY CERTIFY THAT I HAVE READ AND cXAMINED THIS AP- <br /> PLICATIONANDKNOWTHESAMETOBETRUEANDCO�^cCT.ALL <br /> I.EGaLOESLRIPIIONOFPROPERTY�SI�OWNO[LOWORRITNG�IFOUliCOPIES� PRCVISIONSUFLAWSANDORDINANCESGOVERNWCiHISiYP'c <br /> �oi_�e�oc�or S �I�. �Pr 1 All p \'f j<'�'c� OF WORK WILI BE COMPLETED WITFI WHGTIIERSPECIFIED HEqE <br /> IN OR NOT.Thl[GRANTING OFA PERMITDOES NOTPRtSUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANC[L THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REG ULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUR/EOFCONIflACTOROflAUTHORI2EUAGEN7 OATE <br /> PPOJECTAODqE55 <br /> / s��—.����� . �O'�r '�6 <br /> /C � r,..,� APPLICAIPSCRYOUSW[SSIJLLNSENO <br /> '���.�—��/ - ./ li V C_ <br /> PLUMBING MECHANICAL — <br /> N�• TYPE UF FI%TURE FEE NO. TVPE Of EOUIPMENT FEE <br /> - WATERCLOSET�TOIL�1 I m AIRCONU. UNITS-H.P.EA. <br /> BATHiOB � _ qEFRIGERATION UNITS-H.P.EA. <br /> _ LAVATURY(WASH BASIN� �C��_ pOILERS-H.P.EA. — <br /> SHOWER L __ GAS FIHEO AG UNITS-TONNAGE EA <br /> L KITCHEN SINK 8 OISP. FORCED AIR SYSTEMS-B.T.U. M EA. QO <br /> � DISHWASHER � WA�LkIEATERS-BT.U. M <br /> LAVNDRYTRAY 11NITMEATERS-OT.II. M <br /> CtATHES WASI/ER � EVAPORATNG COOLERS <br /> WATER HEATER CLOTHESORYERS � <br /> URINAL VENTILATION FAN - <br /> DRINKING FOUNTAIN pANGE 11000 � <br /> •S� <br /> FLOOR DRAIN Alfl k1ANOLING UNIT- C.F.M. <br /> VACUUM BREANERS STOVE <br /> ROOFORAINS-RAINLEADERS METAI FlqEPLACEB CHIMNEY <br /> SINK�SERVICE-BAR,ETC.� _ WOODSTOVE/FIREPLACEIIJSERT <br /> — �'['�d i �,r-r=— _ <br /> � sv <br /> r � <br /> — �L=�-�tl <br /> SUB TOTAL sb �-'�-- �_ <br /> - __ SUBTOTAL 5 <br /> �,.y PEpMIT S _ pEqMIT q <br /> I TOTAL FEE 5 SD TOTAI FEE 5 (f0 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL ��� <br /> FRpNiSEipACK q[ARSEIpACK SiDESEiBACK PL/NGHLCHNUMOGfl �'INNCIIEGHi[E <br /> ZJ � �� ✓i� t>W � —UlQ_' rer��� �/� nccQ�y7J� <br /> u5E znNE loTnnEn <br /> R-I O VAGANi SI1E — <br /> ��(��7J%. O SOO J}'ES pN0 FEES _VALUATION F[E <br /> iIPEOFCONSi OCCIIPAIICYGROUP NO.OFOWELLINGUNRS <br /> � � ��� ��'/ / BUILDING �y!y� � <br /> 511�dIs11L�G M�/ NOOi51001F5 MAXOCQLOAO ��j�-�-V' �� ¢�� � <br /> ( D <br /> � / � PLUMBING ����1n <br /> -cJ G <br /> MECHANICAL <br /> FIHE SPRINKLERS REOUIRED ❑ YES �NO _� <br /> OTHEfl .:..�j`j <br /> /i <br /> aPP�.iCAiIONACCpY PLPNSCHELNEf1BY APPfiFOBI55�ANCEpY PENALTy <br /> � �� '— TOTAL -- <br /> � ' <br />