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APPLICATIC^1 FOR CONSTRUC7'"'JN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PF INT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION I! COMBINATION ;! BUILDING I i MECHANICAL ❑ PLUMBINO �SIGN <br />OYYNEP MAIL�DDRESS CITV ZIP P110NE ��- <br />C� �RrV1� c���ItJL'�, �1-'r�x.1�,T <br />/UNT IM�LADDRESS CITV ZIP �/ PlIONE <br />T.�r�r� , i' a, n_ � . �.�. . n_ i...t .�_.. ., . L/ Il`��-'L_. 1 .��'s� r.i- . <br />IIRCNRECTORDESIGNEN 1MM1�DORE55 CRY ZIP 1 Pl1�lE ��(�� <br />5��1�A�ati�ntb �3 ��wd �, . � �. �rr,o►.�, Wa.ye�5i.•eas.a�ya S� �,.z <br />� OENEHALCONTMCTOR MALADpiE33 CITV ZIP PMONE STAiELICENSE� <br />MECWWICM.CON7RACiC1N NALADDRESS CITY ZIP PNONE STATELICkMSE� <br />❑ NEW C� <br />k a, <br />f.: �.hr : ��+:t <br />� <br />CITV ZIP P11pNE $T�TELILEHBE <br />v <br />N ❑ REPAIR I I DEMOLITION L J WOODSTOVE/FqPL INSERT ❑ BUILDINO RELOCATION <br />CONPICT PERSON M1D PIIONE NO. <br />�— Y�1Mrr�� KDrf.1"' � �ArC.�it/Z <br />OR ATTACII PoUR <br />�SN0INER <br />I KITCHEN 3lNK 8 DISP <br />qSHWASHER <br />UWNDRY TRAV <br />CLOTHES WASHER <br />URINAL <br />, pRINKIN6 FOUNTAIN <br />� FLOOR DRAIN <br />i 611CKFLOW PREVENTERS <br />p00F DRAINS—RAIf�kEADERS <br />I SINK (SERVICE—BAR. ETC.� <br />� <br />i <br />I <br />i sue <br />PERI <br />TOT� <br />I FOR OFFICE U8E ONLY: <br />I �� ����� <br />mEa <br />�C.':v`]a��7:'"":T3i �: <br />LOTARE� <br />rvre a coxsr. �cnu� <br />NO.OF STORIES <br />FIRE SPRNI0.EIIS REO'D <br />SIDE SEIBACN <br />••17. v�`II <br />octw�c� Ko orow[urvGuints <br />raa. <br />61SEMENT <br />cm oF EvenErr <br />�0� ��8 <br />TAX CODE IS 9105 <br />i HEREBY CERTIFY THAT I MAVE READ AND EXAMINED THI3 <br />APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL <br />PROVISIONS OF LAM/S AND ORDINANCES (iOVERNIN(i THIS iVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFlED HEREIN OF <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIYe <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION OR 7HE <br />PERFORMANCE OF STRUCTION. T I AM AUTHORRED BV THE <br />ONMER OF THIS PERTY/ �TO� PERF M THE YVORK FOp NMICH <br />APPL T�ON 1 ADF{/rynD 1 C PLY WITH THE STATE <br />C �RS 27i;iVAND 200WAC. <br />FORCED AIR SYSTEMS--B <br />UI�R HEATERS—B.T.U. M <br />L�_1:'d�:.�:�:7 <br />.�'I '. .�1�: <br />FIREPLACE INSERT <br />HEAT PUMP <br />EXHAUSTFAN <br />BUILDIN6 <br />PLUMBIN(i � <br />MECHANICAL <br />ADDITIONAL PLMi GHECN <br />SPRINKLER <br />STATE BUILDINO SURCHARGE <br />PUBIIC WORNS <br />TOTAL <br />s <br />