Laserfiche WebLink
fAI ENIQIMO <br />cin ov <br />ewerett <br />BUILDING DEPARTMENT <br />259•8810 <br />�7r•�` ct i�) <br />�PPLICATION FO`:� <br />� C�NSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br />OWNER � � M�ILAODNE55 CIIV IIP PHONE <br />{ <br />OR OF'SIONEH <br />zio <br />PWMflINOGONiRACtOR MRILA�URE55 CITY ZIP PHONE UCENSE• <br />GL�SS Oi WORN ,.��- <br />❑ NEW ❑ ADDI710N L7 ALTERATION ❑ REPAIR ❑ OEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDIVG RELOCATION <br />VnLWTION OF WORKICO51 OF MFfERULS PLUS LABORI <br />7�.-� /'1 �� <br />.�.t��•GY'lUY i^'�LKUO�1 /"]�-• <br />USE OF BUI�ING n y/ <br />S/bo/ I��Jmrr /v <br />LEGR�pESC IPtIONOFPqOPEPTYISHOW 9ELOV//ORRIT,A..pGNFOI <br />io��_aiocK_oF �l-�✓.� r (� /�t-c. <br />10JECT�ODNE55 <br />�S3 / ���,-�� <br />PLUM8ING <br />NO. TYPE OF FI%Tl <br />I WATEHCLOSET�TOILET� <br />� BATHTUB <br />� UIVATORY�WASM811SIN� <br />KITCHEN SINK S DISP <br />OISMWASHEH <br />LAUNORVTRAV <br />CLOTHES WASHER <br />URINAL <br />OAINNING FOUNTAIN <br />FLOOR DRAM � <br />SINK <br />rvPE OF CONST. <br />sae a: sioo <br />RVPLICRLION ACC <br />f �e <br />C•L'! <br />sueir,r�� S <br />PEPMIT f <br />TOTAL FEE f <br />R SETURCK SIDE SETBRC <br />AFE�. ypCANT5ITE <br />OYES ONO <br />:UP�NGYGROUP NO.OFOWF.L <br />OF STORIES MAN.00C. LC <br />Y 0-tl �'%'I . <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES CaOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED H[RE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEAFORMANCE OF CONSTRUCTION. / <br />SIGNATURE Of CONTRACTOR OR AUTHORIZED AGENT pATE/�/ ^/^ 7 <br />X <<r� � � <br />�i�1,��-���,ti�..� <br />pPPLIC�NTS CIfY BUSINE55 LICENSE NO <br />MECHANICAI. <br />FEE NO. TYPE OF EOUIi <br />Cf .0 A/C — NHNOLG UNITS — H.P. <br />BOIIEflS — B.T.U./N.P. <br />OAS FIRED A.C. UNITS — B.T.U. <br />FOPCEO A!R SYSTEMS — B.T.U. <br />WALL HEATERS — B.T.U. <br />UNI7 HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERHEATER . <br />WOOO STOVE <br />MEfAL FIREPLACE S CHIMNEV <br />FlREPLACE INSERT <br />HEATPUMP <br />9l18 <br />PLAN CHECK NUMBER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />S7ATE BUILOING SU7CNANG <br />STATE ENERGY S:JRCHARGE <br />PUBUC WORKS <br />TOTAL <br />FEE <br />$ <br />M EA. <br />M <br />M <br />PECEIPT NO. <br />PROPERN OWNERS AFiE RESPONS�BLE FOR DETERMININO ALL <br />PROPEfiTY LINC LOCATIONSAND RELATED EASEMENTS. <br />