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� <br />A�PLICATIG.J FOR CONSTRUCT. JN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />259-8810 <br />I� DEMOLITION ❑ COMBIiiA710N �BUILDINd O MEI:HANICAI ❑ PLUMBINO ❑ SIGiN <br />OMMER IMLADDRESS CITY ZIP F:IONE <br />IMIL ADD(iE53 <br />CITY 21P <br />ARCHIIECT OR DE3q11ER MUIL �DORES9 CT' 21P PHONE <br />! DY�x�/ A�i/rrevs i�oz .��bu.vrr �'�n Ev�-r;r cv�a �'maoi aOG .�5f �la/ <br />� OENEMLCONiRACTOR IMILMDRESS CRV IIP PlIONE STAIELICENSE/ <br />��3 <br />. �cwwiwcanriucra+ eu�,�ooneas cm nv rnor� sr�reuc�r+se� <br />. PLUMBMOCONTWICTON IMILADDRES6 CITV LP PIIONE STAlELICENBE� <br />C1A880F W0111f <br />❑ NEW ❑ ADDlTION <br />❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDINO RELOCATION <br />CONTACTPER30HAN HONENO. <br />�• <br />nn � /.�.._. ecc`i /li/unu/�/ /10../��swi-f <br />� ___.___...___ -.__- _ _ _ _ _ _ <br />' DElCRREWORKANDBOWIREFOOT INVOL <br />PNOP09ED USE OF BUILDNO <br />1EU11L DEBCRIPTION OF Pf10PEf1TV (5110WH BEIqN OR ATTACN FOUH COPIEB) <br />I wr °�°a oF <br />. <br />I <br />i <br />rno�c.�oo�ss � <br />lZ2� �/2 Gaai_s,�-as_a7 Fii <br />r�.uws�o <br />N0. TYPE OF FlXTURE OFI REM FEE <br />� WATER CL03ET (TOILET) <br />� e�rHTue <br />LAVATORY(WASH BASIN) <br />E SHOWER <br />P <br />� KITCHEN SINK s DISP <br />_ DISHWASHEH <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />E DRINKINO FOUNTAIN <br />k FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />{ ROOF DRAIMS—RAINLEADERS <br />FOR OFflCE USE ONLY: <br />FIIONi8E7l11CK REAR9ETBACIC <br />use za� <br />OF BIOB. <br />INfl11� BV <br />wr,w� <br />TOTAL FEE <br />�crua <br />P1M73 MPROVED BY <br />�� <br />oa�wncr �ro.now¢ixauxire <br />.aair � .� <br />HEIOHf LpARATI(X7 <br />asc- 3�4� <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI3 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCc3 60VERNIN6 THIS TYPE OF <br />WORK WILL BE CAMPLETED Wn'H WHETHEH SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO YIOLAtE OR CANCEL THE PRO�'SIONS OF ANY <br />OTHER STATE OR LOCAL LAW RECiULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF P��rn PERTY TO PERFORM THE WORK FOR WHICH <br />APPLICA �J IS �AADE, AND I COMPLY WITH THE STATE <br />CONT TORS LAV���1827/pCiW AND 298200 WAC.� <br />� <br />FORCEDAIRSYSTEMS--B.T.U. M E.A. <br />CLOTHES DRYERS <br />WATER HEATEH <br />METAL FIREPUICE 6 <br />fIREPLACE INSERT <br />QAS PIPIN6 <br />BUILDINQ <br />PLUMBIN6 <br />MECHANICAL <br />ADDRIONAL PUN CHECK <br />SPRINKLER <br />STATE BUILDINO SURCHAROE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />PERMIT <br />TOTAL FEE <br />a9P� <br />H <br />9 ; oa <br />