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' • ., . <br /> ��.�,,,,, . �PPLICATION F ``' . �,,, <br /> « , �� �-, ; .'� . ::=� ';CONSTRUCTION ` <br /> � .. �eVe1'ett PERMIT e <br /> BUILDINO DEPARTMENT <br /> 269-6B10 TO BE COMPLETED IN INK• PLEASE PRINT <br /> � � O DEMOLITION �COMBINATION �UILDING ❑ MECHANICAL O PLUMBIN(i O SION <br /> :i pypf� � MAII�DGRE84 CITY 21P MONE <br /> � .Uiia.v.= M,�:.v ian� .��.,iiii7 F..��h�r ��8.�0� �-s,--a-5/� '� <br /> MICMITECTd10ESqNER MI1R11DORE59 Cltt Ilo PMONE <br /> � � Rn�il�Tl �oio �7S/715T 5'� �iiE�i--rT i�u� 353-,os3i <br /> � 6ENEMLCOMTXACTOR MML�UONE�S CRV ZIP pHONE LICENSF� <br /> /,�i�a�� '�vv�r'•2ueT.�v a._ 90�T Ev�:,e�-�r 9�gao/ a s�as�o'`�"+�ei3an <br /> j�p�N11LµCONTMGTOq MML�DDRESS CITY 21P PHONE LICEN�E� <br /> � ` <br /> KYIMNIOCONTMCTOR M�IL1100RE39 CItt 21P WpNE LICENSE• <br /> �� CLM/OFWOIIR <br /> Q NEW �ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO RELOGITION <br /> J WLY�TIOMOFWOi1N�G0lTOFM�TERIAL8PlU8L�lORI <br /> 7 +�00�7 � <br /> w wa�K <br /> :�i/.LO .�? LC�oo D ,�*r'.2An�6 f�a i - <br /> 'uaawuona I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED Tf11S AP <br /> PLICATION AND KNOW TME SAME TO BE TRUE AND CORRECT.AlL <br /> � /��µ��r�y[�i�oivn� �woe�tt.ewroue�� PROVISIONSOFLAWSANDOROINANCESQOVERNIN6THISTYPE <br /> �1�y' � OFWORKWILLBECOMPLETEOWITHWHETMERSPECIFIEDMER& <br /> ` b INORNOT.THEORANTINOOFAPERMITDOE3NOTPRESUMETO <br /> GIVE AUTMORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTMER STATE OR LOCAL LAW REOULATINO CONSTqUCT10N <br /> OR THE PERFORMANCE OF CON9TRUCTION. <br /> . . ♦ 810N�TURE OF CONiRACTOR OR AUTMORIZED�OENT OATE � <br /> , <br /> .� � � Q ��� <br /> .`„lIqMCT�Op1EY PPL fSdTrlU NElSLICENlENO <br /> v. ;• <br /> d ' <br /> :KY��p MECHANICAL • <br /> NO. TIIN Of RRTUII[0111TtM �[L NO. TYM ORlWNrMlNT R[ <br /> w��ao�er naun NC—MRWLO UNItS—M P. <br /> Mnmw n�niccwmaa urxn-N.r.u <br /> uv�ro�r nv�e�+s�aiNi eoaEna-e.r.u.m r. <br /> a�qwEn o�s Fineo wc.wnTs-s.r.u. • <br /> arc�wn s��nc a oroa. sa+ceo�in svsrnas-s.r.u. r Ew <br /> aa�w�a w����rcaa-a.r.u. <br /> uurro�r nur uwir�w�na-s.r.u. <br /> aonKt w ev�voa�nvE <br /> cxo <br /> v¢ <br /> D <br /> OW FlIlVENTEIIS iE1111f/1T[R <br /> d1MW-MINLGDERS WOOD STOVE <br /> a�c i�emnu—s�R Ere.� �nu Fin¢auce a c�n�r <br /> nnExwcc i�r <br /> /IEAT PUMP <br /> OAS RMNO <br /> � E%NAU9TFAN <br /> NI�TOTAL f NM TOTAL <br /> !lMII7 t RIIIIIT <br /> TOTK F![ f TOT�L R[ <br /> i11pNTSEfMCR IIE�pSETMCK lIDElETMC1( 7�/�NCMECK UAABER FFE NQCE�PTNO• <br /> g� � 34a � 3�z <br /> � U9EIONE IOi�RE� y���N ITE FEES VALUATON FEE <br /> e,./ /� �uj OYES�iO � <br /> � TYPEOff�yST. rI OCCUP�pNGYGROUP NO.OFDWELLINOUNIT9 BUILDING S <br /> ' V� ��/� q�y � PLUMBIN6 <br /> iRFOFlIDU NOOiSTORIE9 M�M.OGC.l0�0 <br /> ; /` S I .r� Z � MECHIINICAL <br /> J <br /> OTHER <br /> I F PqINKLERS REO IRED O VES N STATE BUILDINO SURCMAR6E <br /> STATEENERQVSURCMAR6E <br /> •VPIIL�iION�CC Bv P�ANSCNECREDBY �PPR.FORISSU�NCEBY <br /> PUBLIC WORK9 <br /> �m � G � G. TOTAL <br /> ����/�i ��� �'� PROPERTYUNELROCATIONSA DRELATEDEA3 MENT9.NOALL <br /> � ��.iv <br /> 1�"� � it,��` �!'R,�• <br /> .,_.r_... . ._ . .____.. ...._._ . _..,. .. . _ <br /> �. .� <br />