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;�:pPLICATION FC��. <br /> `°.`"�°,»� CO N ST R U CT I��1 `�"°" <br /> cin or <br /> t�verett PERM IT e <br /> BUILDING DEPARTMENT <br /> 259•BB10 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION O COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> TVNER M11L�DOPES$ CIfV II{' PNONE <br /> >g�..Ow��'�R�LI, ��nk Rn{�t �°.c��...XT �2ar 252-�67�- <br /> •FCHI�ELf( OtSONE NM�4DDRE�S Clh 21P GnpNE <br /> 4ENEHALyC-�ONI�P�G�10� MMl�OUPESS C��r LiP nuONE �If.ENSF r <br /> �X d-�1 I�G' <br /> M[CIIANI���(�ONiN�GIOq M�IL�ODf1l55 �pY jIP PIIONE llLtflSE• <br /> FWMBINiCONIRA(,�ON M�II.��ONE55 CIIY 211` PIIONE IICtNSE• <br /> GU55O!WONK .. <br /> ❑ NEW � �ODIiION ❑ AITERA�ION ❑ REPAIR ❑ DLMOLIIION ❑ WOODSTOV[/fRPL.INSERT ❑ BUILDING NELOCAIION <br /> veiu�non or won.ir.os�or uertnuis ru�s i�nnni A 7J— <br /> 11 a l0 n.« O�n,�. a�Q.�l .�t, [}�a. )�a3K, �� �-a` C_; <br /> oFSCniBE oAn � u , <br /> U.uA �. [L1..o.c�l1 <br /> usE or auuo c <br /> I IIEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br /> PLICATIONAND KNOW THE SAME TOBE TRUE AN�CORRECT.PLL <br /> IEO�L0E5CRIPlipNO�VROPERrv�4nOWN9ELOWONstinCRfOUnGO�iESi PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> ioi�Y�eiucK�Z�or �` OF WORK WILL BE COMPLETEO WITH WHETHEH SPE:CIFIED HERE- <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> � GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �NY OTHE9 STA7E OR LOCAL LAW REGUTATING CONSTRUCTION <br /> UR THE PERFORMANCE OF CONSTRUCTION. <br /> 'icv�tunEorcor+inecroaonnun�onizEoeoeNr n�rE <br /> I �- LY � �/iT�r l' �� � ..:1u " �.� <br /> 1`ROJECf�DDRESS AP �IUryL•,CI BUb� SSLiCLNiENO <br /> � <br /> PLUMBINO MECHAhICAL <br /> NO. TYpE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUtPMENT F!E <br /> WATER ClOSET�TOILET� NC—NNNOIO UNITS—M P. <br /> BATHTUB PEFRICER�TIONUNITS—MP EA. <br /> UVATORY�WASM B�SINI BOIlERS—B.T U/M P. <br /> SMOWER GAS FiRED AL.UNITS—B T.U. <br /> NITCHEN SINK 8 OISP FORCFO�IR SYSTEM9—B f.U. M G. <br />� DISHW�SMEfl WALI HGiENS—BJL. M <br /> IAUNONYTR�Y UNI7MEATERS—B.T.U. M <br /> CLOTHES W�SMER EVAPOf1ATIVE COOLERS <br /> UNINqL CLOTI'ES�RYERS <br /> ORINKING iOUNTAIN VENTILATION FAN <br /> FLOOR OP.AIh qANGE NOOD <br /> B�CKFLOW PRE'JEMTERS WATER HEATER <br /> ROOi DRAINS-�FAINLEADERS WOOD STOVE <br /> $INK�SERVICE—BAR,ETC� METAL FIREPI.ACE!CMIMNEY <br /> FIREPUCE INSERi <br /> MEATPUMP <br /> aA5 PIPING <br /> EMHAUST F�N <br /> tUs TOTAI. � EUS TOTAL <br /> PERMIT { V[qM1T <br /> TOT�Lf![ f TOTALFE[ <br /> niUNt�F10�Ch rIE��BE�B�Ce S�D[SUBee� �'��NG>IECNNUMBEfI FEE PECEIPTNO. <br /> uSElONE ��1�AE• V�G�Ni51fE FEES VALUATION FEE <br /> []vE5 ONO <br /> BUILOING S <br /> tYPEOfCOhSi OGGUV�NCYGNOUP NOOfOWFLLM0UNR9 <br /> PLUMBING <br /> S�tE Of BlDO MU Of SION�ES M�k OCG LO�D <br /> MECHANICAI <br /> OiNER <br /> FIRE SPR�NKLERS REOUIRED O VES ❑ NO STATE BUILDINO SURCHARGE <br /> STATEENERGYSURCHARGE <br /> �YPUG�IIONeCCBv P��HgCNECKEDBY �p4ql0111SSUANGEBY <br /> PUBIIC WORNS <br /> TOTAL <br /> PROPERiV OWNER9ARE RESPONSIBLE FOR DETERMININO ALL <br /> PROPERTY LINE LOCATION9 AND RELATED EASEMENTS <br />