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I MeEve�green AI'FLIC�TION F�. fi e�eretl <br /> ��TM�� CCIN �TRUCTION O <br /> �ver�tt PE RM I T <br /> TO BE C�MFLETED IN BLACK INK— FLEASE PRINT <br /> BUILGING OEPT. <br /> 25S-f3745 ❑ COMBINATION � BUILDING ❑ �JIECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWrvF�, � !,. r C;+v Tr rnnuE <br /> / y� 7.y/- / -!`L�,�Z �'�f•Y �/�( <br /> /��1�� 7/f 1c /; ( � -%t 1 r '� � -!!i7 E tl �ll,� � --C-1"l /7 <br /> ♦.CNi15��0 OESIGtlEP •1 � ��M�,��RCOF 55 �..��Y -��' f�NCL <br /> / <br /> < � �7 <br /> �3' �'-,--�- 1��„� / ��-� ,� /��.�_ }f � 4=, ��-,�� z5s�— ryi L_ <br /> f.ENF.Re LOLiBnCiOR NniL PODqE55 .� .� !]iV JIP CI�Ot�E �L:�!I.`..0• <br /> �,.L:�{, � l��N<, �„�� J G%,+S�:�C /5�� S' �Y- :=Z�fi-°,�, 77 ���i�(��ii��I�c��`�� <br /> I:.EC4ANICR��OfIiR�GTOq IARIL�PDRE55 ❑rv LIP `110NF UCpI$G• <br /> �:Ok y%//t�LGlO' I y�PE55 +J Lrt�: tiP Re)NE liCfryti[. <br /> J % � <br /> (� ��'l C.i ,.�_ �-.. <br /> cinss o�rvonrc <br /> ❑ NEW ❑ AD�ITION ❑ ALTERATION ❑ [PAIfl ❑ DEh10LITION ❑ WOODSiOVE/FRPL.INS[(iT ❑ BUILDIt1G F�ELOCATipt: <br /> �]lUAIiON O�WORN ICO51 Of IAAIERIALS PIDS LAEUqI ��� <br /> �`� � <br /> OESCRipE V:OR <br /> u d ; s �� /'r <br /> ri � -�_.r-"'�7-`7�-1�` .__ <br /> IISE O�f+�il�itiG <br /> � '�, I HEREEiY GERiIFY THAT I HAVE READ A�1� FXA�dINFO THIS A�'� <br /> /' T,� PLICATIQNANDKNOWTHESFIdETOf'sFTRUEAIJUCOfIR[Ci.A!.L <br /> �cen�o senivriori rcaa�ru�r�s�orn�ecwwa�n�inp�rou�:co,�i�s� PROVISIONSOFLAWSANDORDINANCESGOVERhll�JC.T1i15TYf P <br /> OF WORK WILL BECOIdPLETEC.�WITH WHLTHEFl SFEGI,-IED H[R'- <br /> �ot_etocr_or INORNOT.THEGR4N(INGOF4PER1.11iDOESNGfPRESUMEI_` <br /> GIVE AUTHURIiY TO VIOLATE OR CANCEL TFIC- PRO\�ISIONS OI <br /> ANY OTHER STATE OR LOCAI I,qV/REGULATING CO�JSTRUCTIC': <br /> OR THE PERFOR6I�NCE OF CONSiRUCTION. /! / <br /> SiG�Jn1 REO,r('�c/pNrR�.Cr N1onM�tloyf� D/.C11rlt D�rE /!//C/ � 'r <br /> ��G` i S,��j �L � Y��%r�r � <br /> ��G o � -,�L -,c_a,� X � j �, Lt L�- —c—,��— <br /> FROIEC�.AODBfS$ )/ AI*PL�C4H I'S CI fV E3USR1t551JCC�lSE NO <br /> �� ,/1. � <br /> ��• G t�Pt L .E, , <br /> PLUMOING � MECHANICAL _ ___ _ <br /> N0. TVPE OF FIXTURE I FEE NO. TYPE OF EOUIPMENT F[E <br /> --} �-- _'—_ -_-__ " . <br /> L,� WAiERCLOSEi(IOILEn _ I �O AIfiCON� UNITS-NP.EA __ _ _____ _ <br /> -�- __ <br /> BA7HTU0 fiBFRIGEfinTIOG UNITS-HP F.F___ ___ <br /> L �AVATORY�WASH 9ASIN� � CO DOILERS-HP.EA __ _ <br /> SHOR'ER GAS FIR[D A.C_UNI75_TONNAGE EA_ ___ <br /> KITCHEN SIIlK 8l71SR fORCED AIR SYtiIEMS-B.i.0 Id EA _ _ _ <br /> DISNWASHER Y:ALL HEATEFS-BS.U. M <br /> LAUIJDRY7RAY UNITHEATERS-A.T,U. M _. <br /> CLO7HE5WASHER EVAPORATIVECOOLERS __ <br /> WATERHEAIER GLOTHESDNYE�S ___ __ _ � <br /> URINAL -- VENTILAiION FAN — - _ �_. . (. <br /> pRINKING FOUNIAIN fiANGE HOOD _ _ ___ _ ' <br /> PIOOR DRAIN A!R HANOUNG UNI7- CF1A. _ _ _ _ <br /> VACUUM BREAKERS SiOVE_ _ _. <br /> ROO�DRAINS-RAINLEADERS METFL fIREPIACE A CHI6INEY .. . <br /> SIIJK�SEFVICE-�AR,ETC.� WOO�STOVEiiIFEPLACE R15ERT . �._, � <br /> - -_' _ _.' 'J. <br /> - _ _ - — __ _ _ t._ ,:. <br /> SUB TOTAL _____ SUB 70iAL 5 ____ � <br /> '_'__ ___ ——- - <br /> _. <br /> PERMIT S PEHMIT 5 �' � <br /> -__ . _ ._-_____—_' " . _ —_ _—__-_-_____'"-__-"__{-.._ ._-..__ "' ._ .. <br /> TOTALFEE S� ___"_"__"__TOTALFEE "_'_'_'__ . Sj_ _'_"___ ,_' ' <br /> THIS PORTION "f0 BE COMPLETED 8Y BUILDING DEPT. PERSONNEL <br /> VqONI �E�PnC« nCnHSLR�n�n SiqC5C1NACN �LnNC��li- i:u��?In �[L c��•'� .� �- -.. . __ � <br /> u..[xnyE ior nn[n / I '/L ^' _(_0�__ , �2 S J�_'--_ <br /> Y�C�Ni511E FEES VnLWIION �EE <br /> L'/Ic pN0 —_ --- -- <br /> �V�IOfCONSi OCC01'I�NfYGROUP NUOFDWELIINGUN115 - <br /> � — � ' <br /> 6UILDING =ya eov y �3 oo � � <br /> 5'�IE 0�6LOG MO.OG SiV�+�65 M��K OCG LO�� -- /� -- <br /> PLUIdpIt�G `(J CQ T <br /> 1dCCHANiLAL _ - <br /> FlR@ SPRINKLEFS REQUIRE� O VES ❑ NO <br /> OiMEP ,- <br /> FENALTV <br /> PPP1441�ON�[C.BY PLANSCHECKEDBY ��944pRIS5pAMf.EU� - --' --- '- - <br /> ii �� :i � <br /> ..� TOTAL �.� � � IC U <br /> �= /� , ��\�:. ; `��`• --------- ----— - <br />