1809 MADISON ST 2016-01-01 MF Import

f's � �ti.` ��P�icArioN Fo� a� '".E"'°"'° CONSTRUCTION ciTr or ever. �tt PE RI►� tT BUILDING DEPARTMENT 259-8810 TO BE COMPLETED IN INK• PLEASE PRINT ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL �PLUMBING ❑ SIGN , � �EHEPALCOHTR�GtOR M�ILAD�RESS CIIY ZiP PHONE LIGENSE• ❑ NEW ❑ AODITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION UVE OF LOt_ .. BLOr �� PIUMBING IVATER CLOSET ITOILET� BATNTUB UIVATORY�WASM BASIN� SHOwER LAUNDRVTPAV CLOTHES WASHER UHINAL ORINKING FOUNTAIN FLOOR ORAIN ' 512E RPPULAl10N RCG. BY — nnuv�cnuc . — BAR. ETC.) SUBTOTAL VERMIT TOTAI F�E VAC�NTSITE . OTES ONO NO.OFOWELII OF STpqIE9 � M�X FEE I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWSAND ORDINANCES GOVERNI NG TH IS TYPE OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFE- IN OR NOT. TI1E GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � . SIGNATURE OF C/ON/TRR �OR/OR AUTNORIZED AGENT OATE X� /�bi .: l!.� lI/,. rl L.-�6 MECHANICAL A/C —A/HNOLG UNITS — H.P. REFRIG�RATION UNITS — H.P. FJ1. 901LER5 — B.T.U./N.P. GAS FIRED A.C. UNITS — B.T.U. FORCED Aiq SYSTEMS — B.T.U. ( WALL HEATEqS — B.T.U. UNIT HEATERS — B.T.U. VENTILAT�ON FAN RANGEHOOD WATEF HEATER WOODS70VE METAL FIREPLACE FIREPLACEINSERI HEATPUMP PoAN CHECK NUMBER SUBTOTAL PENM17 TOTALFEE �FEE BUILOING 5 PLUMBING MECHANICAL OTHER STATE BUILDIN6 SURCHARGE STATE ENERGY SURCHAiiGE PUBLIC WORKS TOTAL M M RECEIPT NO. PROPERN OWNERS ARE PESPONSIBLE FOR DEfERMININ4 ALL PROPERN LINE LOCATIONSAND REIATED EASEMENTS. !