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i ��.E�Fo..� �PPLICATION FCi�� <br />CONS��tIJ�TION <br />� cev�rett PERMiT <br />/ BUILDING DEPARTMENT TO BE COMPLETED IN INK • PLEASE PRINT <br />� 259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OWNER %iN • I AI�IL AOORE55 ��ry Z1P <br />,'�_ i-.....4__ .� 7/00�.,,.,..�,..,.. .i..•t G-a Ew.�,dt yFaoL <br />O PLUMBING <br />PHONE <br />�75,�•' 7/Do <br />everett <br />� <br />�SIGN <br />���w�v v "— M�RPDORE55 -- LITV uv •�.u.c <br />� pRGNItEGi Ofi �ES� ER <br />� OENER�ICONiRRG10'a M�ILAOORE55 C��V 2iP �'��ONE L6ENSE• <br />. C� �� �a . � �;.�,..tP- S�ao� �:��-as-�s- <br />MECNANIGL GONIlIhCiOB M��L �DORESS ��N Q ZiP PRONE ENSE • <br />��`��� <br />' . MRII ApDliES$ ���Y �SE • <br />� C�L�,(SSOf WO�N <br />V'J. NEW ❑ ��DITICN ❑ ALTERATION ❑�7EPAIR ❑ DEAIOLITION ❑ WOODSTOVE/ffiPL.INSERT ❑ BUI�DING FELOCATIDN <br />' VAWRt�ONO�M'ORKICOSiOIHAIEAIRL5�L115U00lil <br />�'�(9CJo - _ <br />LE04� <br />�m— <br />i <br />PLUMBING <br />� Np, TYPE OF FIXTI <br />� WATER CLOSET I701LET) <br />� BATHTUB <br />i LAVATORYIWASH BASIN� <br />• SHOwER <br />' HITCMEN S�NK 8 DISP. <br />DISHWASHEH <br />� I LAIJN�RV TRAV <br />� ROOF <br />. SINK I <br />I � <br />� iPONTSETO�CK <br />r <br />USE j,pM:. ' <br />�� <br />' rvFEOFCONS� <br />A4PLIC4110N <br />FOUNTAIN <br />.— BAP`E7C.1 <br />�� <br />CB ♦ <br />I HEREBY CERTIFY THAT I HAVE READ AND EKAMINED THIS AP• � <br />PLICAT�ONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL I <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITN WHETHER SPECIFIED HEFE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OF CONiRACTOR OR AUTHORI2ED AGENT OA7E <br />X Q�_ . �'�+� ///��/ 1 � I� <br />i�/+�"'1 <br />MECHANICAL <br />ITEM FEE NO. TYPE OF EQUIPMEN7 <br />A/C — A/HN�IG UNITS — H.P. <br />REFRIGERATION UNITS —M.P. EA. <br />BOIlEPS — B.T.U./H.P. <br />GAS FIPEO A.C. UNITS — B.T.U. <br />FORC[D AIR SYSTEMS — B T.U. R� <br />WALLHEFTERS—O.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVECOOLERS <br />CLOTHESORVERS <br />VENTILATION FAN <br />RANGEHOOD <br />— WATEH HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACE INSERT <br />HFAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />PEflM�T <br />TOTAL FEE <br />nEAR <br />vncnuT sire <br />OYES �NO <br />NO OF OWELLINO <br />OCC <br />9Y <br />PLANI:HrCK NUMBEH <br />SUBTOTAL <br />PERMIT <br />FEE I AECt�PT NO. <br />$�� ����(� � <br />BUILDING <br />VLUMDING <br />MECHANICAL <br />OTHER <br />STATE �UILO�NG SUACHARGE <br />S7ATEENERGYSUF7CHARGE <br />PUOLIC WOHKS <br />TOTAL � <br />PROPERTY OWNERS ARE FESPONSIBLE FOR DETERMINING AlL <br />PROPERN LINE LOCATIONS AND FELATED EASEMEIyTS. <br />