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APPLIi�.��+1T10N FaR CONSTR.,JCTIQN <br />PE'':MIT <br />Ihe CvsrOrann evcrrit <br />GTY OF , <br />ever�;tt , �- e <br />BUILDINO DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK —'PLEASE PRINT <br />�IIC11Ii[C10RDEBi0NF11 M�Il�D00l39 Giv IIP RqNE <br />6fN[��lCAH11UG100 M�4�DUI�Ii^v'—�_— Ct1Y ----- ZIP 1MIONE IIQNlE• <br />n�saui nuww <br />❑ NEW ❑ <br />GpNtR�LT f'f110E Oi WpNK <br />wt RIOCN or <br />VlUMe1N0 <br />ra. i— <br />SHOWEN <br />KITCHEN SINK 6 DISa. <br />URINAL <br />DRINKIMG rOUNTMN <br />FLOOA Di451N <br />BACKFI JN' PREVEHI <br />ROOf ORIIINS — RAII <br />SINK (SERVICE — &U <br />�it[ <br />rm[ srnwKiens neoumco o res n No <br />emt�qq�OqACC Cr <br />ON ❑ REPpIR L� DEMOLITION ❑ WOODSIOVE/FRPLINSERT ❑ BUILDINONELOCATION <br />r�p) CAHII�Cf PE�SON �ND P110NC NO <br />(F� <br />) n y(' 1/ );ar . l,t �ll�-R�t <br />ITEM <br />❑r <br />oH <br />FEE <br />❑ YES ❑ NO <br />I NEREBV CERTIFV TIIAT I HAVE REAO AND EI(AMINED TNI9 APPLICATION AND <br />KNOW THE SAME 70 BE TRUE AND CORRECT. AlL PROVISIONS OF LAN9 ANO <br />ORDINANCES GOVERNIN6 TMIS TVPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIEO IIEREIN OR NOT. THE ORANTINOOF APERMIT DOE9 NOT <br />PRESUME 10 61VE AUTIiOFItt i0 NOLATE OR CANCEL TNE PAOVI910N9 OF <br />11NV OTHER SUTE OR LOCAI, LAW pE6UUTINO CANBTRUCTION OR 7HE PER� <br />FORNANCE OF CANSTtil1CTION. TNAT I 11M AUTMORIZED BV THE ONMEP OF <br />iNIS PROPERiV TO PERFORM THE WORK FOR NMICH APPLICATION IB MADE <br />AND I CAMPLY WITH THE STATE CONTRIICTORS LMN 1827 RQN AND <br />296.2tl0 Wn�. <br />$qN�'VPEOfGOMIRk10�n/1P�Ut11011VEDA0EM D�R <br />N �. A I il.. Y l.J' / it� 1.� A.� l\I'1'�1 _�X I <br />MECH�NICAL <br />NM — NrinUlV UIV IJ � R� <br />FORCED AIR SYSTEMS— fii <br />UNIT MEATERS— 6T.U. M <br />CLOIHESDRYERS <br />VENTIIATION FAN <br />R�NGEHO00 , <br />WATER MEAlER <br />FIREPLACE <br />HEAT PUMP <br />BUILDING <br />PLUMBINCa <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCIiARGE <br />PUBLIC WORKS <br />TOTAL <br />S <br />