Laserfiche WebLink
APPLICATIO�. FOR CONSTRUCTIL N PERMIT � <br />TO BE COMPLETED IN BLACK INK--PLEASE PRINT <br />BUILDING DEPARiMENT HEATING SVSTEM: GAS ❑ ELECTRIC ❑ � <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION �BUILDINO ❑ MECHANICAL ❑ PLUMBINO ❑ SION <br />OWNEN WLLMME59 CffY iq PNONE <br />�v�r uS/.✓6.AU7JJeGry i4,,, oau,e ev� w� rv.roi aa� �►a��'uzr <br />TEIUNi IMILMOPE68 GIY Z/ PNONE <br />MLNitELTOR0E5pNEH MALMME85 CIiY Zip %qNE <br />dYf�xM� A,�t"i/rrev5 i�oz �,b�vrr ^��Z Evezeir- uiA r0ao/ �o� �5t 3�6/ <br />�ENEIULCONTMCiqi 1MlIDDPE83 CIiY ZIP PHpNF 5111ELICEM9EI <br />Yc 3 <br />MELWWIGLG01liMClOP WRIWNE59 GIT' rP PHONE Si�TELILEMBE� <br />C1A550� WpiN <br />I I NEW I I ADDITION �iERATION <br />CONTPACLPPIGEOFNOIYt ���OL <br />DESCHiBEWOPItMpSWMEFOOt EttNOLV p <br />rnoro=�o use ov auKou+a <br />LE6LL OESGHIPTpH Of VPOYENTV I�M�M �10V1 pP�T <br />LOT BLOLN OF _ <br />?� J"y/�- C/Jod _ev-oL-ef-�n-i� <br />BINO <br />TVPE OF Fl%TUflE OR I7EM FE <br />WATER CLOSET (TOILET) <br />BA7HTU0 <br />LAVATORV (WASH BRSINI <br />SHOWER <br />KITCHEN SINK 8 DISP <br />FOR OFFICE USE ONLY: <br />i1bNi5ETBK'If NFJASEfBACK <br />INiN(E BY <br />PH01f2 Si�TE LICEHSE � <br />I.I DEMOLITION I I WOODSTOVE/FRPLINSERT I_I BUILDIN�RELOCATION <br />GOHt�CTPEP50NIJ1qpNONE1q <br />i... � %�. _ K......��L l�✓u�..i. / n0�./.�.�� <br />asc-s�ai <br />I HEREBY CERTIFV THRT 1 HqVE READ AND EXAMINED THIS <br />APPLICRTION AND KNOW 7HE SAME TO BE TRUE AND CORRECT. A�l <br />PROVISIONS OF UWS AND ORDINRNCES OOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PflOVISIONS OF ANY <br />OTHER STATE Ofl LOCAL UW HEGUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF 5 P PERTY TO PERFORM THE WOflK FOR WHICH <br />�PPLICA ON IS AD AND I COMPLV WITH THE STATE <br />CONTfl TORSU 1827 WAND296.200WAC. <br />X ✓�✓� <br />sauiwc w� <br />BUILDINO <br />PLUMBINO <br />MECH/JiIGJ. <br />�OOITIONAL PUN CHECN <br />SPRINNLEfl <br />STpTE BUILDINO SURGIUN(3E <br />PUBIIC WOHKS <br />TOTAL <br />M <br />11ECEIPiIq. <br />, <br />% <br />0 <br />