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APPLICATION FC�R ��e,�„ <br /> '"'E""°'"" CONSTRUCTION e <br /> cin or <br /> �verett PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILUING DEPT. <br /> 259•8745 �CpMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> � <br /> OWNER MAIL�DDIlE55 GITY LIP FIIONE `D <br /> TE/ZRA ��'ALT�' PO 8oX �'11 �-�NNW�oD yB�3le �d8/-7Goo <br /> APCIIIIEGTOROESIPNER MRILPDDPE55 GITY ZIP PNONE <br /> MdLVANNYIARcN�r��75 /22�� NoRTNup wAY $E[.e6Vtl�, 98�5' 68/-76oa <br /> �ENER�ICONTA�CIOR MFILAODRE55 �CITV ZIP PNONE IIGENSE• <br /> EJ� t Cltt 2iP PM�N[ I�CENSE• <br /> M[CNANICALGONIH�CtOfl M�ILAODflESS <br /> �1 II <br /> P W MBINO GONiR�GTOR <br /> MRILADORE55 CIiY ZIP PHONE LICENSE• <br /> �1 11 <br /> CLn550F WORK <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRP'..INSERT BUILDING RELOCATION <br /> �' <br /> VALUAiION OF WORN�COST OF MR1ENiA�S PLUS LABOPI <br /> 1 OOo DDo - <br /> OESGRIB WORM. D PA 'v P� <br /> NEW CM�J 8�-a�G � IL <br /> vseor'em�ou+a I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> /ZErAI� SALES PLICATIONANDKNOWTHeSAMETOBETRUFANOCORRECT.AI.L <br /> LEO�l0E3CpIP710NOFPflOPERTY�SNOWNBELOWONATir1CMFOUFCOt'IES) PROVISIONSOFLAWSANDOROINANCESGOVERNINGTHISTYPE <br /> IOT�BIOCIC_�OF <br /> INFORNOTNTHEGRANTINGOFAPIERMITDOE NOTPRESUMETO <br /> ANYO HERSTIATEOR OCALL�AWREGULATINGCONSTR�UCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> � SIQNATUREOFCONTRACTORORAUTHORIZEDAGENT DATE <br /> x �,�,;,,,_, ,DMi9 a/� es <br /> ppp NTS YBUSINESSIICEN5EN0. <br /> PROJECT�DPRESS �E� ��� <br /> � ��5 � <br /> PLUMBINO MECHANICAL <br /> FEE NO. TYPEOF EOUIPM^•NT FEE <br /> NO. TYPE OF FI%TUNE � <br /> WATER CLOSET(TOILEn BD AIR COND.UNI7S—H.P.EA. <br /> FEFRIGERATION UNITS—H.P.E0. <br /> BAiHTUB <br /> LAVATORVIWASH BASINI BOILERS—H.P.EA — <br /> GAS F�flED AC.UNIiS–TO�lNAGF EA <br /> SHOWER -- <br /> KITCHEN SI�K 8 DISP. � F�RCED AIR SYSiEMS–B.T.U. M EA. <br /> WALL HEATERS–B.7.U. M <br /> OISHWASHER <br /> UNI7HEATERS–B.T.U. M <br /> LAUNDRYTRAY <br /> CLO7HES WASHER EVAPORATIVECOOLERS — <br /> / WATER HEAiER CLOTHES�RVEFS C�-- <br /> UFINAL - O D VENTILATION FAN <br /> ORINKING FOUNTAIN • O RANGE HOOD <br /> 7. FLOOP DRAI ' NIR HAN�LING UNI7– G.F.M. <br /> VACUUM BREAKEiiS STOVE <br /> ROOF GRAINS–RAINLEAOERS O idE7AL FIREPLACE&CHIMNEY — <br /> � SINK SERVICE–BAR.ETC. ZI VdOODSTOVF/FIREPLACE INSERT <br /> SUBTO7AL S <br /> SUB TOTAL _ <br /> PERMIT 3 PERMIT s — <br /> TOTALFEE S <br /> TOTALFEE s <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> PUN GHELN NUMBEP Pl9N CH[CK fEE <br /> FRONi5E1 RCK RERRSETBAC% SIDESETBAC�� FEE �% RECEIPiNO <br /> p ' � �S �� /5�.�3 �- /7�3 60 <br /> USE20NE ��TA�EA f. D VACENTo9jTOE FEES VAIUATION FEE <br /> L-/ G"s � S� � <br /> TYPEOFCONST. OLCUPANCYGROUP NO.OFOWELLINGUNITS — <br /> � 5 2 6O <br /> � N �j�2, BUILOING Q�' ____ <br /> SIZE OF BLOQ NO.OF STOi11E5 MRX OCQ lOp� � O <br /> /)'1 Z('J j ,r �(/,����' /G�3 PLUMBING _ <br /> MECHANICAI � <br /> FIRE SPRINKLERS RE�UIRED YES ❑ NO OTHER <br /> PENALTV <br /> RPNIICAiION RCC.BY PLANS CHEGKEO BY RPPR.FOF ISSURNCE BV q � // D a <br /> 10TAL "< <� <br /> �� ��� <br />