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;t �. ',; <br />° �ic PLICATION FOk°��% ���,�„ <br />;�. �.Ew.�� tt , CONPERM TTION e <br />Gn oc <br />� evere <br />a BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br />258-8810 <br />O DEMOLITION �COMBINATION ❑ BUILDiNG � MECHANICAL ❑ PLUMBING ❑ SIGN <br />i pWNER MML �ODPESS GIIY 21P PHONE <br />a� ww � 3K st,o� �£[,.r+4... 98,0� s*r��BL►� <br />�i ��ry 21P FHONE <br />MGHITECTOR�ESIONEP M�IL�OORESS <br />� <br />;� OENEMI CONTP�GiON M�IL �DORE55 Cltt ZIP vHONE ��CENSE • <br />. G,ceASl /3SeL <br />YMVIVC <br />t�� <br />„�,..,,.�,���..... 9s3 � i'u�r.�s iy a� <br />e a �ouF W.l�c�.ca Buc�cerr 9��[ �' <br />WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPl.INSERT ❑ BUILDING RELOCATION <br />dIONOFWOPKICOSTOFM�jfi�iSPLUgL�BOR1 lD —_+.-� <br />,� a ix•�r� <br />-LI.SI <br />CO212 �� <br />PPOJEG7�DURE68 <br />��� <br />PLUMSINO <br />- NO. � TtlPE OF fl7ITU <br />� WATER GLOSET ITOILET) <br />9ATNTUB <br />� LAVATORY (WASN BASINI <br />SHOWER <br />� I KITCHEN 91NK i 013P. <br />URINAI <br />OPINKINO FOUNTAI <br />FLOOR DMIN • <br />BACKFLOW PFiEVE� <br />ROOF DRAINS — M <br />SINK ISERVICE — 8i <br />Zo' <br />USEZONE <br />P.-Z <br />ttPE OF COy$T.� . . . . <br />� <br />�SREOFBL00. ' � <br />/06o S.F, <br />fU! TOTIIL <br />PERMIT <br />TOTAI FE! <br />� <br />f� ��I <br />;IOE 9ETB�CK ' <br />si <br />��C�NT SITE � , <br />GES ONO <br />NO. OF pWElLINO UNI <br />� <br />M�K. OGQ 10�A0 <br />�T <br />CHEGNEOBY �PPA�FORISSU�NCE <br />.�'.s.� L . G <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORHECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BECOMPIETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATINCaCONSTRUCTION <br />Ofi THE PERFORMANCE OF CONSTRUCTION. . <br />SIONATURE OF CONTRACTOfl OR RUTHOflIZED AOENT DAiE <br />X ,�-�f ,�A•�tla� ��-I-B� <br />�PFLILANTS CITY BUSINESS I�CEN4E NO <br />MECHANICAL <br />- A/HNOL6 UNITS — H.P. <br />'�IOERATION UNIT$ — H.P. E <br />ENS — B.T.U./H.P. <br />FIREO A.C. UNITS — B.T.U. <br />�on ��a 9vSTEMS —B.T.U. <br />UNIT HEATERS — <br />HOOD <br />HEATE <br />STOVE <br />HEAT PUMP <br />OAS flPINd <br />�Q� 1 �Q���i� IFE�/I��� IREC_I �C <br />BUILDING � r/ <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SUACHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY UNE LOCATION3 ANDNRELATED EASEMENTIS ING AlL <br />