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1 <br /> ; �.E,�„N, '. .PPLICATION FO�` ���,�„ <br /> ever�tt CONSTRl1CTiON 5��. � <br /> PERMIT <br /> BUILDING f)EPARTMENT <br /> �59�8745 TO BE C�MPLETED IN INK• PLEASE PRINT <br /> O DEMOUTION C7 COMBINATION Ji�l�6U1LDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> ����✓/��I `-'� G�L/1'{'� �f/L� / ESWN4/^�BC'�V YVT�R�i� IIP PNONE <br /> 1 — <br /> ARCNRECTORD[SIGNEP � M�ILII0DRE55 �Yf �iTY 21P PIIONE <br /> �o-ru�uv � . � c�7�� ,ae�r��' �t��uri 9sa-�3 Z5�- 2(7y <br /> GENER�t CUNiH�CTOR M�II ADDqE55 Cltt 21P PMOYE IIGkNSE• <br /> � � N k c1 u bi ?3`d'2lzy Sf�rNUc:/�//�-�o <br /> MECH�MCQ CONTR�LTOfl MAIL�DOP'c55 CITY ZIP PHONE UCENSE• <br /> PWM0iN7CONiR�CiON M�ILADDN?55 CITV ZIP 1`IIONE L�CENSE• <br /> C1�550f WORN <br /> �.� NEW ❑ ADDITION ❑ ALTERATION ❑ R[PAIR ❑ DEMOLITION ❑ WOODSTOVE/FqPL.INSERi ❑ BUILUING RELOCATION <br /> V�i J�iION Oi WORd�COST OF M�IENi 0.5 PW S L�BOfry <br /> �s Uo <br /> OE� i0E WOPx <br /> �CL��'�� F �` rPs�r�en� � <br /> USE OF IIl01NG — , <br /> ��J I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> .�sm�� �� �`«� GS PLICATIONANDKNOWTHESAMETOBETFUEANDCORRErT.ALL <br /> lE0�L0E5LRIPT10N0 PROPE TYISMOWNBELOWOfl1TTAGMfOURCOPlE51 pROViSIONSOFLAWSANDOR0INANCESGOVERNINGTHISTYPE <br /> -����i $tli�� 12 oF.�v� �s7— ,0(y u f� �� UFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDMERE• <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE �'ROVISIONS OF <br /> ANY OTHER STATE GR LOCAI.LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMAI�CE OF CONSTRUCTION. <br /> � SIGNAT EOFCONTRACjQbORAIIT 2EDAGENT DATE <br /> // ,` y/ <br /> _ 'Vl�\! � U���—CJCJ <br /> PRO�EC1eDORES$ � AP C�NTSCITYBUSINESSLICENSCNO. <br /> �A?-0 l QD�l6'l�i2BlA�e- <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTUNE FEE NO. TYPE OF Ei�UIPMENT FEE <br /> WATER CLl SET�TOIIEn AIR COND. UNITS-M.P.EA. <br /> BATHTUB RFFqIGERATION UNITS-H.:'.EA. <br /> LAWTORYIWASH BA:�NI BOILERS-H.P.EA. <br /> SNOWER ' GAS FIRED AC.UNITS-TJNNAGE EA <br /> _ KIiCMEN SINK 6 DiSP. FORCED AIR SV:.TEMS-El7.U. M EA. <br /> �ISMWASMER WALL HEATERS-•B.T.U. M <br /> LAUNDRY Ti7AV UNIT HEATERS-3.T.U. M <br /> CLOTHES WAJMER EVAPORATIVE CUOLEHS <br /> WATER HEATER CLOTHES DRVERS <br /> URIN�L VENTILATION FAN <br /> DRINKiNG FOUNTAIN RANG[HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- QF.M. <br /> V�CiIUM BREAKERS STOVE <br /> ROOF DRAINS-RAMLEADEFS METAL PIREPLACE 8 CHIMNEV <br /> SINK�SERVICE-BAR,ETC.` WOOOSTOVE/FIREPLACE INSERT <br /> SUBTOTAL SUBTOTAL f <br /> 1'ENMIT f PEHMIT f <br /> _ TOTALFEE i TOTALFEE f <br /> THIS PO^TION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONISqEt�B�CK RE�flS�ET/B��CK SIDESETE�CN PUN[�CNECNNUMBEN PL�NCNECrcfEE <br /> W "W �Q q�/� � 73�a FEE 5��� flEGE1PIND (�j/O�� <br /> tJ 1�/ d � <br /> USEZONE LOT�PE� V�C�NTSITE <br /> R �Z OYES MjJO FEES V�LU�TION FEE <br /> TYPEOiCONS,T1 Of.CUPANCYGROUP NO.OFDWELLINGUNIiS <br /> �v ' • �� I BUILOINO S��•i D ry) <br /> 512E Of BIpO NO OF ST�JRIES MA%.00G.tOAp <br /> q ,f, � � PLUMBING — <br /> MECHFNIC�I <br /> FIRE£PRINKLERS REOIIIRED ❑ YES g NO <br /> OTIIER <br /> PENPLTY <br /> ♦VPUG�110NACC0Y PLANSGNECItECBY APPRFOpI550ANCE0Y — <br /> TOTAL <br /> Vl1 II/� ol �.� G . G . - <br />