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� .. <br />,�.E�ro,,,,, ,PPLICAT10�1 FO.- ���,�„ <br />��TM�F CONSTRUCTION e <br />evere�t PERMIT <br />BUILDING DEPARTMENT <br />259•8�45 TQ BE COMPLETEO IN INK • PLEASE PRINT <br />Fd"DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER M�IL�ODRE55 Cltt 21P PHONE <br />r2.�! /�.,,1.,, /„ �.. /�r�s,�_l � 715' /�%f y ST S. C: `�ic.�,�,� ����cv �3���s- <br />PLUMBINGCONTR�GTOR MMIAD�RESS CITY 1�V PIIONE IICENSE� <br />G NEW ❑ A�DITION ❑ ALTEFATION ❑ REPAIR DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDI'JG RELOCATION <br />VRL'JqTION OF WORN�COST OF MIITEFI�LS FlUS L�BORI <br />u <br />•DDRE55 <br />3 � � �� G'2 -��. �t <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PAOVISIONSOF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION <br />OR /T?1EPERFORMANCE OF CONSTRUCTION. _ <br />SIGiATUAEO�LONTRACTORORAUTNORIZEOAGENT DATE`I—��`'aG <br />� 7 /�j pi <br />X � � _ . . .��� /�� _u! <br />REFRIGERATION <br />AIR <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />RERR LETBRCK .�DE SETB�CK PLAN CNECR NUMBER PL�N MECN F[E <br />FEE I �ECEIPi NO <br />USE20NE ILOTAREA I[7 ES ONO I FEEB � V�LU�TION I FEE <br />CONST <br />512E OF BLDG I N0. OF ST^91E5 I MA%.OLC. l0>D <br />UNITS <br />BUILOING S <br />PLUMBING <br />MECHANICAL <br />OTMEfl <br />PENALTY <br />ACL BV PLANSCNELKED BY APPR FORISSU�NLEBV <br />/ / TOTAL <br />/ �,/ . <br />G�. <br />