Laserfiche WebLink
�-�:PPLICATION FO� ���,�„ <br /> '".`",°'"" CONSTRUCTION e <br /> cirr oc <br /> evexett PERMIT <br /> BU�IDING DEPARTMENT <br /> 259 e7a5 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEN • . �ILAODRESS G�T�' 21P V110NE <br /> _�_(b�f=l I k��( � C� l �I I Crn�r��CJ� �'� �a�p� 9�?,�1'� 3�5-5 3� <br /> •RLIUlEC104�E5i0NEN� M�IL�DDRESS <br /> GENER�IGONIRRCTOR MAII�D�PE55 ��TM 21P PMUNE LICENSE• <br /> MECH�NIUICONIRAGTOq M�ILAODRE55 CIIY ZIP �HONE UCENSE• <br /> C MAIU�ORE54 pTY JP FI�ONE IiLENSE• <br /> FLUMOINCiCONIRAGfOR <br /> GL�55 OF WOPN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOIITION WOODSTOVE/FRPL.INSERT � ❑ BUILDING REIOGATION <br /> V�LU�TION OF WOAN�GOST Of RUILOIALS PWS L�BOPI <br /> OESCRIBE WORN � <br /> �;.�T ���L��F Pi LAC► �_l.�� �' <br /> USE OF Bl11lDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BETRUEANDCORRECT.ALL <br /> ica•ioe PIPiI NOFPNOPEFTY�SHOWNBELOWON�TT�GHFOUPCOPIE51 pROVISION50FLAWSANDORDINANCESGOVERNINCaTHISTYPE <br /> OF WORK WILL BECOMPLETEf`NITH WHETHER SPECIFIED HERE- <br /> �oT_Bio�K—_oF IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SI6NATURE OF CONTRACTOR OP AUTHORIZEO AGENT DAIE <br /> X �.f��i O..Y��o �'Ozr �G'-. ��1�-�; <br /> aPPUC�NTSCITY8U51wE55ULEN5E . <br /> PROJEGf�ODPE55 � � <br /> � MECHANICAL <br /> PLUMBIN6 FEE NO. TYPEOFEOUIPMENT ' FEE <br /> NO. TYPE OF FIXTUHE <br /> WATER CLOSE7(TOILET) AIR COND. UNITS—M.P.E0. <br /> BATHTUB FEFRIGERATION UNITS—H.P.EA. <br /> LAVA70RY�WASH BASIW BOILERS—H.P.EA. <br /> SNOWER dA5 FIREO AG UNITS—TONNAGE EA <br /> KITCHEN SINK 8 DISP. FORCEO AIR SYSTEMS—B.T.U. M EA. <br /> DISHWPSHER WALL HEATERS—B.T.U. M <br /> LAUNDRYiRAY UNITHEATERS—B.T.U. M <br /> CLOTHES WASMER EVRPORATIVECOOLERS <br /> WATEH HEA7ER CLOTHES DRYERS - <br /> URINAL VENTILATION FAN <br /> DFINKING FOUN7AIN RANGE HOOD — <br /> FIOOR DRAIN A�F HFN�LING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAWLEADERS �AETAL FlREPLACE d CHIMNEV <br /> SINKISERVICE—BAR.ETC. WOODSTOVE/FIREPLACEtNSERT <br /> SUB TOTAL SUB TOTAL S Qi.'- <br /> PERMIT 3 PERMIT s <br /> TOTALFEE ! TOTALFEE s :U �� <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL ; <br /> �BONf5El0�CR <br /> RE�RSEIB�CK SIOESElOALK PUNCNECKNUA�OER PL�NCIIECNiEE <br /> iEE PECEIPI HO <br /> USE20��E �OT��E� V�CANTSIfE FEES V�LII�TtON FEE <br /> OVE9 ONO <br /> ttPEOfGONSf OCCUP�NLYGROIIP NO.OFDWElLiN0UN179 �� <br /> BWLDINO 5 <br /> 54E OF OlOa NO Oi SiORlE3 M�X OCC.IO�D <br /> PLUAIBINQ <br /> MECHANICAL C <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑ NO Oi��ER <br /> PENALTY <br /> •PPUC��ION�CC OY VL�NSGH`CNEDBY �PVR.fORI35UANCEBV � Jy^� �,1� <br /> TOT�L !J�/ <br /> � <br />