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f��Everyrs�n . .P P L 1 C A T 1 O �V F O�. � <br /> °�TM°` CONPERMITTION eY� <br /> evPr. ett <br /> BUIL�ING DEP;. TMENT <br /> 259-8810 TO BE COMPLETED IN IN. • PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ pLUMBING G SIGN <br /> OWNEfi h1AILAD�P[SS ��ry Z�P pHON� <br /> �'^ •L- �� "t%F'L% r/� .vin n ��'n -i,.:ii;r nt ?`� �i/� !is 9�i5 <br /> hCN LE('1 OR O65 GNER IAA L �OFE55 CItY �� � <br /> Z�P VMONC <br /> GENCPA�LONiRAGiOR IARII�10DRE55 G�rv LIP PI�ONC � <br /> / <br /> LIGCNSE• <br /> /YrE/✓.'ieLS 1'r,'fr _S�•"/.', 2/l2/ Sr '/7�•, �,- �>h!f✓_�cYrrv_r Lc.s�, 9:U39� ��3 �-/�g�'�/ rr�rn ,• <br /> MECIIPYI..4LCONTF<CTOq MALLRDDRE55 ��ty Z�P Sl7Ff�O <br /> PHONE �ICC�15E� <br /> PLl1MBINOCONIRACiOF MAILADDAE55 `.ry z�v p"`"C _ <br /> Li^ENSE� <br /> CLASS OF WORv. — <br /> CI NEW ❑ ADDIiI�iN ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> Vn WPT10N 0(WORfl ICOSi OF M1IATERIAIS PWS LPPORi <br /> 3n./�/n�� / � <br /> DESCR BE WdR <br /> /S/S/�.'i�li� /-"%f�sr/NG- c✓y.Y/ <-'S _(� T L L � ;�I - f'!�� ��.FJ._-%' ._<//SS SNi < -� <br /> usc or emioir�c <br /> � —,�L 1 HERGBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORPECT.ALL <br /> LCGALDESLRIPiiONO�PqOPERTV�SHOWNf1E"�WORAtTAG�FOl1RCOPIE51 PROVISIONSOFLA'NSANDORDI�ANCESGOVERNINGTHISTYPE <br /> �cr_eiocK_ov OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIED 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 /> ANYGTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> $IGNATURE OF CONTRACTCR OR AUTMORI2ED AGENT pa7E <br /> X , /7' jr � <br /> vFo�Ecrnooress � � -'���/ �[7�( ��_ <br /> APP .ANiSCIrvBU5ME55LICE115Ep0 � <br /> /GUO ; " �' .- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIIRURE Oq 17EM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A/C-A/HNOIG UNITS-NP. <br /> BATHTUB REFRIGEHATION UNITS-HP.EA. ' <br /> LAVATORV�WASH BASIN� BOILERS-�.T.0/H P. <br /> $MOWEF GAS FIRE�AD.UNITS-B.T U. <br /> KITCMEN SINK 8 DISP. FORCED AIR SYSTEMS-B.T.U. M EA. <br /> DISITYlnSMER WALLHEATERS-B.T.U. M <br /> LAUNDRV TRAV UNIT HEATERS-B.T.U. <br /> M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAL CLOTHESDRYERS <br /> �RINKING FOUNTAIN VENTILATION FAN <br /> . FLOOR DRAIN RANGE HOOD <br /> BACNFLOW PqEVENTERS WATER HEATER <br /> ROOF DRAINS-RAIN�EApERS WOOD STOVE <br /> SINK�SEFVICE-BAR,E'C� METAL PIREPLACE 8 CHIMNEV <br /> FIREPUICE INSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> E%HAUSTFAN <br /> SUBTOTAL S SUBTOTAL <br /> PERMIT t PEqM1T <br /> TOTALFEE f TOTAIFEE <br /> �RONL SEipACn qE/R SETBs�K StDE SETBACK �LAN CHEGK NUMBER FEE FECEIPT NO. <br /> USEZONE I.OtAREn <br /> vacaNrsire FEES VAWATON FEE <br /> ❑YES ONO <br /> *VPEO�LONSi OCCUPANCYGROUP NOOfOWEL�INGUNIiS BUILDING S <br /> PLUMBING <br /> StZE OF BIOG NO OF SiORIES Mn% OCC LOAO <br /> MECMANICAL <br /> OTHEq <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO STA7E BUILDING SURCHAfiGE <br /> STATEENERGVSURCHAFGE <br /> ;.VPUC:iION:CC f3y P�ANSCMELKE�BY APPq FORISSOANCE9Y <br /> PUBLIC WORKS <br /> TOTAL <br /> PROPERTV OWNEFS ARE RESPONSIBLE FOR DETERMI'JING ALL <br /> PROPERTY LINE LOCATIONSAND RELA'iED EASEMENTS. <br />