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;rett <br />NG DEPARTMENT <br />10 <br />�;'�PLICATION �Oti�' <br />CONSTRUCTICJM <br />PERMiT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />DEMOLITION O COMBINATION �BUILDING ❑ MECHANICAL <br />lverlH <br />e <br />❑ PLUMBING ❑ SIGN <br />�MIn[1� ^'^.�^vvr.caa Vi�♦ lll' PNONL. I <br />�evex� 5rr��1� ��I�l�. 9�^ PI NG ���1-11� �1F,i55 v\��-�la_�-.�'� <br />� �RCllrtlLfOROk5�4NCH MAI�AOD11E55 CIiV pIP PrONC <br />M�IL <br />rn+a eooness <br />��" <br />nr <br />zir <br />n <br />PLUMBINOCONiR�CION v MAIL�pOR[59 CIIY jiP PIIONE UCLNSE •� <br />�W\�. ►'1�vY�i�F�4 ��.c� l�.y�"'nIE FR11�e>/uu_ `l i`,r,� f�P�3 -���E', <br />��,55�� 0 � <br />� NEW ❑ ADDITION Q ALTERRTION ❑ REPAIR ❑ DEMOLITION ❑ WOO�STOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />vsw.no'+ or vronK icosr oF uetenuis n�us unoia Q�, � <br />_ �� �'i.-v'.'�CIi7TT - �%�j Jl�n <br />DESGA�BE WONM � i <br />USE O� <br />or <br />PLUMOIN6 <br />NO. TYPE OF FfI(TURE OP. ITEM <br />WATER CIOSET �TOILET� <br />BATHTUB <br />UVATORY �WASM BASIN� <br />SHOWER <br />KITCHEN SINK 6 OISP. <br />OISHW�SHER <br />UUNORY TRI1V <br />CIOTMES WASHER <br />URINAL <br />iRONfSEIB�CN <br />FEE <br />SUS TOTAL f � <br />PERMIT f — <br />TOTALFEE f <br />AE�RSEtB� N� 510�� <br />� <br />h <br />tOf�RE� VAC�NTSif[ <br />ASES �NQ <br />OCGUPANCYGOOUP NO.OFOWfLLIN4UN <br />R:� � <br />NO 0� SiORIE$ MA%. p�� �OAO <br />Z K.4�• <br />JIUN�GCOY VUNSIMEGI(EOBY /.PPRfOP155WNCE0Y <br />i� j� <br />�� �=� � <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TqUE ANDCORRECT. ALL <br />PROVISIONS OF LAINSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. TI�E GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGU�ATING CONSTRUCTION <br />OR THE PERFOPMANCE OF CONSTRUCTION. <br />SIGNRIURE OF CONip4CTOR O� AUTIIpRIZED AGENi pATE <br />XC � . . 1 . . . 1 � r� _ . . 1 _ 1 ( _ ' <br />MECHANICAL <br />A/C — AiF1NOLG UNITS — H.P. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILEPS — B.T.0 /M P. <br />6AS FIRED A.C. UNITS — B.T.U. <br />FORCED RIR SYSTEMS — B.T.U. M EA. <br />WAILMEATERS—B.LU. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES�NYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WI17ER HE.4TER �. <br />WOODSTOVE <br />METAL FIREPUCE 8 CHIMNE� <br />FIREPUCE INSERT <br />HEATPUMP <br />SUBTOTAL <br />VCRYIT <br />PLA��EC�K 19�81 Fl��� <br />I <br />�UII.DING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />SiATE U�IDING SUf7CNAiiGE <br />STAiEENERGVSURCNARGE <br />PUBLIC WORNS <br />TOTAL <br />FEE <br />NO. <br />PROPERTY OWNEf75 ARE RESF'ONSIBLE FOF DETERMINING ALL <br />PROPERTV LINE LOCATIONS AND RELATED EASEMENTS. <br />