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Nov,m LOT lq I� UI..T I TY. <br />mli C%OLICATION f0� EYEEEN <br />C EEVCF CONSTRUCTION <br />evereit PERMIT <br />TO BE COMPLETED IN BUCK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />0" COMBINATION ❑ BUILDING <br />❑ <br />MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />GINNER <br />MAIL ADDRESS <br />CITY <br />LIP <br />EMONE <br />•ll•� <br />9a/o �v.r•;L.0 <br />LY..I r,;: <br />9�.aoA/ 3dt-7TDo <br />ARELDETaR aNLR <br />CIBT <br />MuuaHiTll <br />uTr <br />nr <br />Px0 E <br />r^ <br />/ <br />OENERAL CONTRACTOR <br />MML ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICE NSEA <br />MECwNICAL CONTRACTOR <br />MAIL ADDRESS <br />cm <br />ZIP <br />PnoNE <br />LICENSE • <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZH` PHONE LICENSE <br />^/ G!7 5 v A%✓.cciT .N•T// �;�/ i S'F.T��y 2 <br />CLASS OE WON. <br />[2'NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSlOVE/FRPL.INSERT ❑ BUILDING RELOCAl10N <br />VALUAT,ON Or WORRIC05T OF MATERMLB <br />EUS LABORI <br />_.,._..._,.._.... <br />n I .- _ -'�l/ <br />o U.Jlnt <br />USE OF BUILDING <br />ILO s1 RT.r/ <br />I H REBY CERTIFY THAT I HAVE READ AND EXAMINED D THIS A L <br />TOBETRUE ANDCORREIS ALL <br />PROVISI NAND KNOWTHE SAMEORDINANCES THIS TYPE <br />OF WORKWILL BECOMPLETED WITH IT ETHERSPECIFIEDHERE- <br />OF WO KWILL E COMPLDORDINANCEETHER SPECIFIED <br />IN <br />GI E UTHOREGRANTI L TE OR CANCEL THE NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRIfCLON� <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGRAILTNE OFCONTRACTOR ORAUTHORIZEDAGENT DATE` <br />X <br />uau DESCRIPTION OF PRaPERmSHowx enow DR ATTACH roan cocas <br />PROP <br />Lor/ �ocl�-Dr •� / / <br />PROJCCT ADORE" <br />ky % / ,L IOC <br />APPIICAN LITV BVBIMESS LICCNSC NO <br />PLUMEINo <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />_ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />IF, 11 <br />WATER CLOSET (TOILER_AIR <br />CONE. UNITS-H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA <br />LAVATORY IWASH BASIN) <br />BOILERS-H.P EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />rL <br />KITCHEN SINK A DISK <br />DISHWASHER <br />FORCED AIR SYSTEMS -BTU. MEAL <br />WALL HEALERS-BT.U, M <br />LAUNDRYTRAY <br />UNIT HEATERS-BT.U. M <br />_ <br />CLOTHESWASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE N000 <br />FLFORDRAIN <br />AIR HANDLING UNIT- CF.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEAOERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK SERVICE -BAR ETC. <br />WOOGSTOVE/FIREPLALE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT E <br />PERMIT f <br />TOTAL FEE B <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />STD, IrtCS SHE <br />CNO <br />-q •l,/ / <br />I OLD. NO OE STORIES MAY 0 <br />zoo u d�v4 Opt Ses. GG <br />-5_�- I %/m. <br />'w.•- <br />d,Q�T <br />BUILDING <br />PLUMBING <br />MECHANIGL <br />OTHER <br />PENALTY <br />OCEB <br />TOTAL <br />FEE <br />FEE <br />