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`���PPLI�ATION F��•:`i <br />• �.. <br />'".E""'"" . CONSTRUCTION <br />uTr oF <br />ever�tt PE RM IT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ UEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />M/.IL�ODRE55 CiIY ZiP <br />�p�.�.. �„<,�..,ti �. �s�.i �x:.,.�,� u�.� � ��� <br />, u�a eooaEss � <br />I <br />/ M�IL 0ltE55n p <br />9 FfS �v .�J7� cT Z'L <br />^ MAIL�DORE55 <br />/l! M/1iL�UCRE55 <br />i Oi WORN <br />NEW ❑ AOQITION ❑ ALTERATIC <br />.TION Of WOHN �COST OF MsiERULS PW 5 L�BON� <br />�ESCNiBE WOPN <br />OF <br />PLUMBING / <br />NO. T'PE OF FIwTUNE OR <br />S N�i�TEN CLOSEf 1T6I�ET� <br />0 <br />ROOF DPAINS — RIVNI <br />SINK �SERVICE - BAR. <br />4USTOTAL <br />PEHMIT <br />TOTALFEE <br />REAq SETBACN <br />IOT�FE� <br />OCCUPANCYGROUP <br />zic <br />ZIP <br />zm <br />kSPLUMBING <br />PMONE <br />�r �» <br />PHONE <br />PHONE � <br />everen <br />e <br />❑ SIGN <br />ENSE • <br />�z <br />ENSE • <br />ENSE • <br />❑ FEPAIR ❑ DEMOLITION �❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />roua cories� <br />SET9�CN <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS AP• <br />PIICATiON AND KNJW THE SAMETO BE TRUE ANDCORREGT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMI'f DOES NOT PRESUME TO <br />GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFOFMAN OF CONSTRUCTION. � <br />IGN� OF Nl'P�TO�UTMOP�ZFO AGENT OATE <br />a 1 • // / / <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT <br />A/C — A/HNDLG UNITS — H.P. <br />REFflIGERATION UNITS — H.P. EA. <br />BOIlENS — B.T.U.MP. <br />GASFIREDA.C.UNITS—B.T.LL � <br />FORCED RIR SVSTEMS — B.T.U. M EA. <br />WALIHEATEHS—B.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPOPATIV'c COOLERS <br />CLOTHESDRYERS <br />VENTILATION FAN <br />PANGEHOOD <br />WATER HEATER <br />WOODS70VE � <br />M�AL FIREPLALE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT Pl1MP <br />GAS PIPING <br />EXHAUSTFAN <br />SUSTOTAL <br />P[RMIT <br />T0T11L FEf <br />PLANCMECK NUMBEH IFEE <br />FEE <br />RECEIPT NO. <br />V�C�NTSITE FEES VALUATION FEE <br />OYES aN0 <br />NO.OFDWELIINGUNITS BUILO�NG S <br />PLUMBING <br />M�IC OCG LORD . <br />MECHANICAL , <br />OTHER <br />S7ATE BUILDING SURCHARGE <br />S7ATEENERGYSURCHARGE <br />APPR.FORISSU�NLE BY <br />PUBLICWOflKS ' <br />TOTAI <br />PROPERTYOWNEFS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTYLINE LOCATIONSAND RELATED EASEMEN7'S <br />