Laserfiche WebLink
-� <br />!� `��lPPLlCATi iON �G`"�t <br />fhoEwrprwn �•veretl <br />� evexe�t CO P����g�TaON � <br />BUILDING DEPT. TO BE COMPLETED IN BLl,CK INK — PLEASE PRINT <br />� 259•874!i ❑ COMBINATION ❑ BUI! GiNG ❑ MECHANICAL � PLUMBIf�G <br />�SIGN <br />]1YNF.R ✓CN � Q4,' MAll4DpRESS Ci Z�� <br />/� P�IDNE <br />�%/(J6c+ /�ntn<N 7L•G I F_.Pa�ah'F.� 5..��r4�7 /=�b.�rry,� Sd2oJ ,�Ss--liu9 <br />�AGNIfECfOA0E5iGNEN M,11�ADOHE55 Cily 1i�, <br />I n��ONz <br />i <br />]E�IERA�CONfR�f,'O�I MRl�qppqE55 pIY IIV 411UNf ��� � <br />IJLfpSE � <br />J�", Ma���xt J-ncSoc. looj �2ui.5/w' liDn�u.�uf L�a SS�ao 77Y /5�`/ Jirtnaql4rrihd <br />MECMANIC�LCONTRA�iOq MAILAO�RE55 CIfY $IP <br />VRONE LILENSE • <br />PLUMBINOCONIReC�Gq M�Il�00RE5S CITY 1'A PMONE <br />ULEIISE • <br />':USSOFWppg � __ <br />NEW ❑ �JDITION ❑ AIfERA710N ❑ pEPqIR ❑ DENOLITION ❑ N'OODSTOVE.�FRPL.INSERT ❑ BUILDWG REIOCATION <br />UW�TiON OF WOAR ICOSf OF MAiENIALS PWS LAOORI _ <br />� DESG('��iOE� WOpN A <br />e� ti��/' <br />JSE O� <br />N <br />I HEREBV CERTIFY THAT I Hl1VE REAG AKD [XAMINED THIS AP- <br />EG�LO[SG�iPIiONOFPqOPERry�511DWNBELOWOR�TTqCnFOUfILOPIE51 PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND OR�INANCES GOVFRNING THIS TYPE <br />Oi_BLOC�OF OF WORK WILL 9E COMPLETED WITH WHElH[f� SPEGIFIED hIERE- <br />IN OR NOT. TN� GRAN7ING OFA PERhl1T DOES NOT PRESI:ME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE P90VISIONS O� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THC ?ERFORMANCE OF CONSIRUCTION. <br />SIGNAIURE OF CONieACTOR OR AU1110RIZEJ AGEN� OAIE <br />X /P'�") 11 • �'C�-..+-�_ 7��//0 � <br />AOJEGiApORE55 AF{', iNiS YBUS SSLIC.FNSFN(t <br />A <br />n�• TYPE OF FI%TURE FEF k0. TYPE OF EOUIPMENT <br />WATER CLOSET(TOI�ET) ' A:q COND UNI IS-VI P. EA <br />BATHTUB - - ' ---- <br />FE1 �IG[RAiION IINITS-H R EA. <br />LAVATOFY I WASM BASIN) pOhEflS- li R EA. <br />SHOWEq — <br />GAS iIRED AC IINITS-Tnuuerc cn <br />ER NEATER <br />WAI.LHEAT[PS-B.T.U. M <br />META� FIREPLACEH CHIMNEV � � <br />WOOOSTOVE/FIREPLACEINSERi � ; <br />_ __'___SUB TOTAL _ __ y -- <br />—. _. PEPMIT r . <br />------ _1._.____ IUTALFEE __ y� I <br />1_ <br />THIS PORTIUN TO BE COMP! FTED BY BU!LDINC: DEPT. PERSONiJ[� ' <br />��ONISEIE�LR REAq SEIBAGK Si�E5E1pACe - --- - - � <br />GLAN LHCLh NUMp6H PIA4 CIICCe 1! E <br />�l:� ��iECHPINO � <br />USE:U�'E LOTAPE� , � <br />91CANi::rtE . <br />OYE.^. pN0 FEES V�LU�TION FEC � , <br />fYVEOFpOHSi y�pP�uf.vr.nniio 1 <br />BUILOiNG s � <br />5i2E OF 9LW YJ.OF 9TORIES MAI� OCC LO�D <br />PLUMpING <br />FIqE SPRINKLERS RE�UIRED ❑ yES ❑ NO MECHANICrII, <br />� O7HER �-- ; <br />�no�iC�tiO�+�CCBr �UNSCNECRED9Y ePPRFOR�55UANCEpv �'ENAIiy � ! <br />'� TOTqL , <br />✓J 1' �7 �_�\ --- -- -- ---- _ -- --- <br />