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i '�-�-aPPLICATiON F�D:�1 <br /> � rne Ev�rprsen everetl <br /> cirroF COf� ST'RUCTiO ��� i <br /> e�erett PERMIT � , <br /> BUILDING DEPARTMENT ! <br /> 259-8745 TO BE COMPL�TED IiJ INK - PLEASE PRINT � <br /> rJ DEMOLITION ❑ COM9INATION ❑ BUILDING ❑ !'AECHANICAL ❑ PLUMBING ❑ SIGN I I <br /> owne r.uanooncss cirv �ir ouor�e I � <br /> Y�/l r� l,J _sz��'ti-- 3(� i�7 i��-��-.�.�f- r�� y�zo 3 �ss-s 7� y I I <br /> ARCHRELLORUESIGNLR AIRIIApOPE55 CIiY ZIP PIIONE <br /> i <br /> ' GENENALCONifV�GiOH A1aIL\ppqE55 p1Y ZIP 4�I�O�IE LiCENSE+ <br /> MECMANICAL CONi11AC10f1 MAtL AOURE55 CIIY ZIP P110�1E LICENSE• I I <br /> P�UMOINCCUNiOM1CiOP �141Lr1UpR[55 CIiY 111' PIIpNE LICENSEi I III <br /> CLn55 OF WOqN I I <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ HEPAIR ❑ UEMOUIION ❑ WOODSfOVE/FRPLINSERT ❑ BUILDING RELOCATIUN <br /> ve�ualior+oF wonrc�cos�ar iamm�ini s rws tnooni ! <br /> �Vi dU�� � � <br /> oEscaioervaian���) (� � ' nJ�/� 'i <br /> ����ti��.:J �� �I <br /> us�oF ouaowc ^ � � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP- <br />, S ` ��`„` ' �� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL � I�' <br /> � LEGAlOESCPIPTIONOFPovearrisuowr�oEiovronnrnu�Four+eovies PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE � �� <br /> �� -�-l � . :$� L OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- I <br /> . _or�:.Le�ocn_oF 1 �'�"� '�W `� INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO ' <br /> GIVE AUTHORITY TO ViOLATE OR CANCEL THE PROVISIONS OF ! <br /> ANYOTHERSTATflORLOCALLAWAEGULATINGCONSTFiUCTION . i <br />� OFl THE P[RFORMANCE OF CONSTRUCTION. ' '� <br /> � sicr�ntu�e or coutnncron on nutHonizeo nc�Nr onte , <br /> X /l��' G-�9-��.- g'/z�L6 <br /> PPOJELTADDRE55 /� 4PPLICANTSCirvpUSWESSIiC[�IS[NO. � � j <br /> �� <br /> 8 9�, c �6zf� <br /> PLUMBING � MECHANICAL _ � <br /> NO. TYPE OF FI%TUflE FEE NO. TYPE OF EOUIPMENT FEE � <br /> WA'SR CLOSET(TOILEn AIR COND. UNITS—H.P. EA. ' <br /> BATHTUB REFRIGER�iION UNITS—H.P. EA. <br /> L�VATORY�WAShI BASIN� �OILERS--HP.EA. � <br /> � Sh10VlER GAS FIfiGU A.C. UNITS—IONNAGE EA ' <br /> KITCHEN SINK 8 DISP. FORCED AIR SVSTEMS-6.T.U. M EA. � <br /> DISHWASHER WALL HEAiE(7S—OS.LL M <br /> LAUNDFV TRAY UNIT HEATERS—B.T.LL M <br /> CLOTHES WASHER EVAPOMiN[COOLEPS <br /> WATER HEAiER CLOiHES DRYEflS . <br /> URINAL VENTILA710N PAN �� <br /> DRINKING FOUNTAIN FANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— GF.M. <br /> VACUUiv1BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADEflS METAL fIREPLACE 8 CHIMNEY �i <br /> SINK�SERVICE-6AR. ETC. WOO�STOVE/FIREPLACE IIJSEI7T � � <br /> I — — —_ II <br /> SU�TOTAL SUU TOTAL 5 ' I <br /> PEqM1T S PERMIT S <br /> _�_ TOTAL FEE S __ _ TOTAL FEE 5 _ _ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL I <br /> ' FNONi SEIpACM. R[AR^EiO�CK SIDE SEipAGK PL�N CIIECK 11U1.111[❑ �L�N CH[CK fF.E <br /> r[r �ee[irre�o <br /> USEZONH L014q[� VACA�IISIIE ---------- — -- <br /> � ❑YES IINC fEES VAIU�TION FEE <br /> � PlFEOFCONSt OCCUP�NGYGROUP NOOfDWELLINUUNIIS <br /> DUILOING b <br /> 512E OF f3L00 NO OF S10n1E5 Mn[ OCC LO�❑ — -- <br /> PLUMBING <br /> ' MF.CHANICAL <br /> FIRE SPRINK�ERS REOUIRED ❑ YES ❑ NO — -- <br /> OiMER <br /> PEN�LTV <br /> RPPLICAiiON FCC pV PLANS G�F.CKEf�OY M`PR fO0155UnNCE�Y — — — — <br /> TOTAL <br /> � \^A —'____ . ._ ___ ....__ ___'_".. _._._. __'_—"— — <br /> — 7 • ' � I _ <br />