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�''��� <br /> hPPLICATION FO�C everen <br /> fn�ErerDrss^ C O N ST R U CT I O N e <br /> Giiv ov <br /> �ver�tt PE RM IT <br /> TO BE COMPLETED IN BLACK INK— PL=ASE PRINT <br /> � BUILDING DEPT. � <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ i%i JMBING �SIGN <br /> OWNEN • lJ�ILAOONE55 GIiY 21P PnONE <br /> 1 <br /> /�L ,C�cJ/ �e"'/' 7.i'" � �5 3o Vr•r•F�'�Pc.'rv' c�,i-7' E'��/T 4�,-t 2 53 —�_! �7 <br /> AFCIUTECTONDESiGN[F IMIL4pOF[55 Cltt ZiP P110NE <br /> GENEfl�LCONTf14CION fAAILADORESS GITY Z�P PnONE LICENSE• <br /> �''x-ru�Y Ns�n/ C?� �ur Po �sc�x s��` tY"i✓.✓ ,vA 9FrvL 77�. �� s;er.i.YN2�l7ci, <br /> IeECHFNIG�LCONiRACIOq 1MRAODR[SS GITY ZIP PNONE LICENSE• <br /> PWM�INGGOKIRACTOP �UILAODIilSS CITY ZIP PMONE LICENSE• <br /> CLBSSOF WORN <br /> ❑ NEW ❑ ADDITION �ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.IWSERT ❑ BUILDING RELOCATION <br /> yeLUATION OF WOqN ILOSi Of IAFT[RNLS PLUS Ln80R1 <br /> .1� .5-��i °"' �" <br /> OCSGNI�G WORN r / "T������ <br /> �'ic'•��ie�c�t .S—:r� 5�y'T� d- gT/S77f'LL CU ST, u�� 5 "S��g'� S��Yv Ttt�'i�'�� <br /> USE OF 6UILOING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> C�C+z.�-n���t�-S7f-� PLICATION AND KNOW THESAMETO BETRUEAND CORRECT.ALL <br /> LEWLDESLRIPTIONOFPPOPERiY�S110WNBELOWORATTACMFOURCOPIE51 pROVI510NSOFLAWSANDORDINANCESGOVERMINGTHISTYPE <br /> OF WORK WILL 6ECOMPLETED WITH WHETHERSPECIFIED HEFE• <br /> LOT-BLOCIt�_OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF� <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUflEOFLONiPACTOflORAUTMOHIZEDAGENT OATE <br /> // il V ( <br /> 'J .7 'O 'r�-t,c� C!.-cJ /GL ' � ..1...-..-�— !I 0' <br /> PROJECTAODRE55 AVILICA PS ITYBUS�NESSLILENSEHO. ' <br /> r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATGR CLOSET�TOII ET) _ AIR CON�. UNITS-H P.EA. _._ <br /> BATHIUB REFRIGERATI017 UNITS-N.P. EA _ <br /> LAVRTOFYIYlASH BASIN� BOILERS-H.P.EA. <br /> SHOWER GAS FIRE�AC.UNITS-TONNAGE EA <br /> KITCHEN SINK d DISP. FORCED I.IR SYSTEMS-B.T.U. M EA. <br /> OISMSYASHEfl WAL�. IIEATERS-B.T.U. M <br /> LAUNDfl1'TRAV UNIT HEATERS-B.T.U. IA <br /> CLO7HES WASHER EVAPORaTIVECOOLERS _ <br /> WATER HEATER CLO7HF.S DRYERS <br /> URINAL VEI:1iLATION FRN <br /> ORINKING FOUNTAIN RANGE HOOD _ <br /> FLOOR DRAIN _ AIR HAN�LING UNIT- GF.Id. , _ <br /> VP.CUUM BREANERS STOVE — <br /> FlODF ORAINS-FAINLEA�ERS METAL FIREPLACEB CIiIh1NEY <br /> SINK�SERVIC[-BAR.ETC. WOOOSTOVE/FIREPLACEINSEFT <br /> SUB TOTAL SLIB TOTAL S _ <br /> PEflM1T S PEHMIT S <br /> TOTALFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONiSETORGK RtFqSEidACK 510[SET�>LK PLANGHECKNUMpER VUNCHECNFEE <br /> iEE RECEIPTNO. <br /> , USE lONE lOT AflEA yqC�NT SIiE <br /> FEES VALIlATION FEE <br /> OYES ONO " <br /> ^� IYPEOFGO�lST. OCGOPFNCYGROUP ��OOFDWEILINGUNITS <br /> �UILOIN6 S <br /> SIZE OF BLOG RO OF STOf11[5 lAFIC OCC.LOAD <br /> PLUMBING <br /> UECHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES L1 NO <br /> OTHEfl <br /> �I PE��ALTV � <br /> APPUCAiIONAC:.�V Pll1N5CM[CHE�OY APF(i.FOf1155UANCEOY <br /> fOTAL <br /> � �.. 6 r�r�J T� � ,o-r�t� <br /> � <br /> u�. /o�lm��r4- o�c./ �2llJ,o7� 192dt'L�`�Y <br />