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;rett <br />NG DEPARTMENT <br />10 <br />�►: PLICATfON FOR� <br />CONSTRUCTION <br />PERA�rIT <br />TO BE COMPLETED IN INK- PLEAS': PRINT <br />DEMOLITION ❑ COMBINATION ❑ BUILDING <br />r}'at OG, <br />x <br />S MECHANICAL O PLUMBING <br />� <br />ziv vMowe <br />��� WY. F–VE�2a-T �i8Z0�- <br />Ok1�ER�L CON1RAplOA Mnll a00HE55 CIfY IIP OHpNE L�CENSE • <br />MECN�Wf.4GON*N1LTOq MPIL�DORE55 CItY 2iV PMONE 4CEN5E� <br />MGDOAIALD M����=�z �c ItOG3 f�AUF�c liwY S. SEA�ftw qBiGS �1G3-`�40o N1ACoor97.yr7,7 <br />_....._...___ ............. uui�Ol]NESS C11Y 2�V PIIONE UC[11..E <br />CLPSS O� VIOR✓ <br />❑ NEW � A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING FELOCnTION � <br />WLU�tIOH Of V:Oqr �COSi O! 6�a1CN�nLS PLUS LABOHi <br />� 127I <br />OESCAiBf WJFK _ MOV(�t <br />! <br />/4CTIVATE EXIS . 1�hV Fi'+�1 IAIDUc7iJ�1 T.=�ZMS• ��1L�'En�&- �LEc-� S7KIJ' NI 7n 1�aX, D�FF��irS <br />�se or eu��o�r+c � 1 HEREOY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />Q('FI G� PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />iCC�lDESGRiPnO��O��AO�ERIvSUOw��OEIOWOP�iteG�fOURCDP�E51 PRCVISIONSCFLAWSANDORDINANCESGOVERMNGTHISTYPE <br />OF WORK WILL BECOMPLETEn WITH WHETHEF SPECIFIED HERE� <br />�o�—e�oc�—or IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOMS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSiRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . ��, <br />SIGNRIUPE OF LONiRqCTOR OR AU1HOpIZEO AGENi 041E <br />x "/ ��1d�2 G(� ,�:c.UtiGr � /L�i3� 8 <br />_____ __.. RPPLILAN SCITYB NESSUCENSENO � <br />SE EUEk'F7T MA�I- wA� , 98Lc�4 <br />PLUMBING <br />Ofi ITEM <br />WIITER CLOSET (TOILET) <br />BATHTUB <br />UVATORY �WASN BASINI <br />KITCMEN SINN 8 DISP <br />OiSMWASNEfl <br />LAUNDRYTRAY <br />CLOTNES WASHER <br />� aU�R SE I��CM <br />USE LUNE <br />f�� n[ O� CONSf <br />VG FOUNTAIN <br />OAAIN <br />� DRAINS — RAINLEAOE <br />�SERVICE — BAR. ETC � <br />SUBTOTAL <br />PERMIT <br />T0TI1l FEE <br />NO Jf SIOPIES <br />FIRE SPRINKLERS REOUIRED ❑ VES ❑ NO <br />eYV�i�;tION �GC Bv <br />f <br />soe <br />V�CFNt SitE <br />QYES ONO <br />NO OFDWEL <br />UY �RPPP.FON <br />FEE <br />MECHANICAL <br />A/C – A/MNOLG UNITS – H.G. <br />PEFRIGERATION UNITS – H.P. EA. <br />BOIlERS – B.T.U./N.P. <br />GAS FIRED A.C. UNITS – B.T.U. <br />FORCE� AIR SVSTEMS – B.T.U. M <br />WALLHEATERS–B.T.U. M <br />UNITHEATERS–B.T.U. M <br />EVAPORATIVE COOIERS <br />CLOTHESORYERS <br />VENTIl,4TION FAN <br />RANGEHOOD <br />YJATER HEATER � <br />WOODS70VE <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPtACE INSERT <br />EXHAUSTFAN <br />f�AN CHECN NUMBER <br />9UBTOTAI <br />PERMIT <br />TOTALFEE <br />�FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEFNERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />Fee <br />RECEIPT NO. , � � � <br />PROPERTV OWNERS ARE RESPONSIBLE FOR OETERMINING ALL <br />PFiOPERN LINE LOCATIONS AND FiELATED EASEMEN7S. . <br />