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„., .,;:� <br />���PLI�A�ION FOf+�`=� <br />'".E"..°,”" CONSTR'UCTION <br />cli'/ oF <br />ever�tt PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br />259•8810 <br />❑ OEMOLITION ❑ COMBINATION ❑ BUILDING f�MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />O HE��J lJL 1�/1� RES� � 14w..1V •\W' L����/ ll.1/IIJ� PNO�aJ � 4� l 1 <br />'n nC <br />f 1 f I � n. Zi PNONE <br />p LHITFf.tORDE5IGNER AUILAODHE55 <br />GENEMLLONIRPC�OR MnILA00RES5 CiiV LIP vHONE LiCENSE• <br />❑ NEW � ADDIiION <br />�o�— <br />7N ❑ REPAIfi ❑ DEMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />ISMOWN BELOW ORRItACM <br />]�DRyE55 //�� 1.� <br />T ! " `�W `� `� <br />PLUMBING <br />TYPE OF FIX7U <br />WATER LLOSET �TOILET� <br />BATHTI'B <br />LAVAfORY�WASH BAS�N) <br />SHOWEH <br />NITCHEN SINK d �ISP. <br />OPINKINGFOUNTAIN <br />FlOOA DRAIN <br />BACKFLOW PREVENTE <br />FOOF DRAINS — RAINI <br />SINK �SERVICE — BAR. <br />rnoHrse?o�ck�� <br />USE IONE <br />rVPE Of CONST <br />SIZE Of OL[1G <br />FIRE SPRINKLER: <br />nvcuunor+ncc ov <br />ITEM <br />SUB TOT11l <br />PERMIT <br />TOTAL FEE <br />RE�R SET6�LK <br />LOT�RE� <br />OCCUPnNCY GRi <br />NO OF STONIE9 <br />V�CANT SIiE <br />pYES ONO <br />MRN. <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. F�L <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHEI'HER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVF. AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAI LAW REGULATING CONSiRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNA7UREOFCONiRACTO(iORAUTMOfi12EDAGENT 041E <br />X' <br />r�', ��� ott� �i 4 1 l-7 �`� <br />1PPLICANT., ITYDlI51NES5LICEN5EN0 <br />MECHANICAL <br />A/C — A/HNDLG UNITS — H.P. <br />REFRIGERATION UNITS —H.P. EA. <br />BOILERS — B.T.U./H P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCED AIR SYSTCMS — B.T.U.� FJ1. <br />WALLHEATERS—B.T.U. M <br />UNIT MEATER'a — O.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHESORYERS <br />VENTIUITION FAN <br />qANGEHOOD <br />WATENHEATER • <br />WOODSTOVE <br />METAL FIREPLACE d CHIMNEY <br />FIiiEP1ACE INSEPT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />PERMI i <br />TOTALFEE <br />PLAN CMECK NUMBEF I FEE <br />PECEIPT NO. <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDIN3 SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAI <br />PROPERTYL�INEL CATONSANDNiiELATEDEASEMENTISINGALL <br />