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APPLICATION Fl�►R <br /> «E««°"'"" CONSTRUCTION �� � <br /> everet� PERMIT <br /> TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br /> Bl:'I.^INO DEPT. <br /> 259•3745 ❑ COMBINATION ❑ Bl11LDINO ❑ MECHANICAL ❑ PLUMBINQ ❑ SI(iW <br /> �N�p1�\ MAIL�UONE99 Cltt ZIP PHONE <br /> AqCM1T CTOR�810��� ��C� MML�DD 89 �v��� CI`Y 21P PYONE <br /> OEN�I�T� OR M�/Jl A^UORE89 ^ (1�TY 2�F FNONE LICENSE• <br /> JJ � (�do.5� Ca �.J- KC � I L s�O�'I'\ .SW � , ��..ruv� Wf �/'7��557 <br /> MECHANIC�LCONTR OR MAIL ADORESS CIiY IP r PM_�ME_ ����Ngf� <br /> �� a�.n, <br /> �r�v.�+- �� <br /> VIUMBINOCONTR L MAIL�DUHE&4 CIIY 21P PMONE LIGENSE� <br /> CL�53OF WOXK ,er����� <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION /'IJ Ref`niR ❑ DEMOLITION ❑ K'OODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VwIWTIONOFNUpKICOSTOFM�TERIhLS�SL�BOPo � <br /> 7�� - <br /> DESCNIBE WOFK <br /> ��;;� s���1�� ,� - <br /> usEor euaoiNa ,{� I NEREBY CERTIFY THAT I NAVE READ AND EXAMINED THIS AP- <br /> OS CS PLICATION AND KNOW THE SAME TO BE?RUE AND CORRECT.ALL <br /> lE0�L0ESCRIPTIONOFPROPEliTY19HOWNBEIOWOR�TTACHFOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHlSTYPE <br /> � t� �.�. OF WORK WILL BECOMPLETEO WITH WHETHER SPECIFIED HERE- <br /> �or�e�oc�_oF�f-�- IN OR NOT.THE GRANTI NG OF A PERMIT DOES NOT PRESUME TO <br /> �J (1 61VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONB 0� <br /> CU eJC'�' 1� J w�e ? 'G S ANYOTHERSTATEORLOCALLAWREGULATIN�CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. ��/�� <br /> �N ^ r J � O �I SIONqTU ONTPACTORORAUiHORIZEDAOENT DRTE <br /> �.C. T <br /> X �-c..�� <br /> PPOJEGT� PESS �7PLIGJlT9GiYBI151NE53LICENSENO. <br /> �O � I«- ; - <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. ' r'PE OF EOUIPMEN7 FEE <br /> WATER CLOSET 101LE AI.9 COND.UNITS—N.P.EA <br /> BATHTUB FEFRIOERATION IINITS—H.P.E0. <br /> UIVATORV(WASH BASI BOILERS—H.P.E0. <br /> SHOWEH OAS FIRED AC.UNITS—TONNAOE E <br /> KITCHEN SINKB DISP. FORCED AIR SVSiEMS—B.T.U. M <br /> DISHWASHER WALL HEA7ERS—B.T.U. <br /> LAUNORV TRRV UNIT HEATERS—B.T.U. <br /> CLOTHES WA EVRPORATIVE COOL 5 <br /> WATEP HEA H CLOTHES ORYER <br /> URINAL vr;;�LL,pt�ON FA <br /> DRINKINO FOUN AI RANQE HOOD <br /> FIOOR DR AIR HANOLING UNIT C.F.M._ <br /> VACUUM BRE KERS STOVE <br /> ROOF DMI PAINLEADERS METAI FIREPLACE 8 CHIMNEY _ <br /> SINN 9E CE—BAR,E7C. WOODSTOVE/FIREPLACE INSER7_ <br /> BUBTOTAL BUBTOTIIL • <br /> PERMIT • PENMIT S <br /> TOTALFEE • TOTALFEE • <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT9ETBM:K REAR9ET&�CK SIDESETB�CN <br /> PL�N CHECK NUMBER PI�N CNEGK FEE <br /> FEE REGEIFT NO. <br /> i <br /> USE20NE ��T�R� yACANT51iE FEE9 VALU�TIDN FEE <br /> OYES ONO <br /> TVPEOFCONST. OCCUPANCYGNOUP NO.OFUWELLINOUNITS <br /> 9UILDINa f <br /> 91ZE OF BLUQ NO.OF 9TORIES M�K OCC.LOAO <br /> PLUMBINQ <br /> MECHpNICAL <br /> FIRE SPRINKLERS REQUIRED O YES O NO OiHER <br /> PENRLTV <br /> APPUC�TION�LC.BY PLANSCNECNED BY �PV0.FOR ISSURNGE BY <br /> TOTAL <br />