|
/ 1 \ �
<br /> �"-.'�' �.'�; � i� ` ' `.. i i ;i�'ii��� _. ; ; ^ ; o
<br /> ��,,,:;^ •,.���„ + � 0
<br /> �:I`,lfl.O�/.Y'.IOY �•• •. • ` ��
<br /> oin.m �c���n�p� l I ,! /J �
<br /> �,.,,..,�,., L3UILLI�G MECIInNICIII_ f'LUi,�l31NG �___. �: ,
<br /> .:::�R tdA1LAlJpI1lS5 !:� PIIUNL `- -I
<br /> /�1�s._.g ,2c�u•.i'r�Y �`�.3���c�f .S� I . ,t'�c��-ii _ �5� - 7� 7 �
<br /> �;�:i:nc' uSi�,c,ILR AtnILl,uunh.S; ,•(;�JTIE —UCIN'.61,•7.- I�
<br /> �
<br /> �..:�tAI.CVaiitilCTOR I,LIILAUUIiCSS PIWYc I.IC[I:tiLNO. �
<br /> -L d_�Sot-Nri�ti' �c� b�/�o=�-�a3 5.�;. .C,�.,�,�w000 '176•di8°CE_3 Ly<Z
<br /> "CI:�:NICALCOt3T(1ACTOfl �dnll AUDIlESS 1':tOt1f. LICLNSG N0. '
<br /> 1
<br /> _ (.,_
<br /> C'.fiuCG C6c.IrtACTOR • R�AIL AOORFSS PU:1Nfl LICENSG NO.
<br /> f�
<br /> _f—.••IT CLl�SS Of\VORK ' .J I
<br /> x:ViL":f:G 1]PLU.'.if71:JG �McCHAG:CAI ,�,/ � , I_-
<br /> �"JE\Y ❑AODITION ❑AlTE11AT10M ❑ft@PAIR
<br /> '.LV,.:IOL'pF �.OftY. CL.
<br /> � C�•j .� ❑DEMOLiSl1 ��ENC& ❑SIGN ❑SW161ldING POOI �' �
<br /> — `� L/ C�. ,
<br /> .L(:fil.::l�JiY,
<br /> _��i_V, ���vi/ ��tS�.IC�
<br /> o;os�n�_.-: m�ciinrvicn�
<br /> _ TVPtOPI'UEL �OIL �rtni. �LPG. �LLEC. •
<br /> AlUESCP:PiIONOfFROPEliTY15HG:JUELOClORATTACH (:AS . '
<br /> �u�z corrts� �
<br /> �r___CLOCY._oF��rC ^�V ��^'�1� ) /�G< <-�S NO. ,_ TYPG OF COUIF'�dC-N7 _ FFG _i
<br /> nia corvn. i�rii-s-rL^. r... 5 i i
<br /> -,-/ —' REFR�GLRATIU:! UNITS-11.1'. EA. �— �
<br /> ' R'T-7 �q �,W�OC �Ar � .2s S i S /n _ ❑oii.[ri� �i r. en_ — �--;
<br /> ��.
<br /> 'I cns rir�o n.c. ur.irs-'rovNnc[ [n. ,, -�
<br /> _/v .53 �T �w l3i f=T �/ S_$3�T �[ t�! Fonceunir..,�srEr.s-a.r.u. n�[n. i
<br /> : ;,u:,ness /� . i�i`, f'T I �vnurirnref�s-aT.u. n,t �—i
<br /> •���,� Y'IJ.(4 S/. C:v'✓x'-(�Z/. VNIT118�11'[RS-n.T.V. h1 1 i
<br /> —"EVAf'OH:�7iVCCOOL@fl, —�--' .
<br /> UF.;31i:G ttoi�i+ts�nv�ns I �
<br /> � � V[NTIL/1TIOWlAN � �
<br /> I i
<br /> RANGE �I:JOU _7__ ;
<br /> �-� Alfl II��h'C]L�NG UNIT- C.F.h1.
<br /> Tl'?E O" FIXTURE OR ITF'A FEE — - � ;
<br /> IlYA7Ed0.C5EiITOiLEi1 g�— iNrlNLitn'f6N I
<br /> _ ' __ �_ --_ . � '.
<br /> -f� ��HTU3 T_ l � i.
<br /> Li.CAIORi U':%.Si/u�51tJi I �
<br /> I; i�P:F:. � �.
<br /> ITCHc\FiNI:bC15P. � SUOTOTAL 5 � i
<br /> c.�S:ilY:.Sf'eF vEne.vr 5—�— �' .
<br /> �—"___ __
<br /> I�..AI!NGR"TflA\' {�— — �---r
<br /> TOTAI.f[E S
<br /> ICLOiMES::>>�+ER - — -j
<br /> - TMI$ PER\+IT HCCO�'ES NULI .+ND VOIJ iF Y:OHY. OH CGr:STHUG
<br /> �_.Y;�TC.P�:EATER TION AUTNbRIZEC IS �:OTCO'dVENCEOI:ItNIN 1?OUAYS. Oa IP �
<br /> �'JRINSL i �nYSTRUCTlO`! Oli C:OftK IS SJ�PEYpEn OH ,:RAVppkF.D fOR n
<br /> _I �:W\IVG FCUNTAIN � _I— PCRIOD OF 120 DAYS AT �1NY 11L:[ l�F7Eli�90F1; ISCOL:'.1cNCE�.
<br /> tf�pCf-$:::Y, Ofi f1qAIN 1 HEiiEFlY CE�TIf-v TMAT 1 IIf.VG HC1D !•':O E1AIdINcb TIIIS A?�
<br /> �b:CVVl' �9CAYCRS ' '— �L�CATIO�: AP:J I:':i.:/ 'iIIC 5.:�.tE TO 6l TINf? /�NO CORRECT. AL1. �
<br /> J--- PIIOVI$IONS D! LAC:S AkD pi!f�lflANCFS G 7VFRNING TIilS TYP@ '
<br /> �ftGOF G�G�'.S-RAI:JLE:.DEFS � OF 1VORK Y:ILI .".E L(`1'ALICU l':ITH IYHESHCR SN:CIFIC� HCREIId I
<br /> �SIF:K ($E�y1Ch-O:.R, ETC.) -- —� O� 1lOT. 1�r1E G�IANi�t:G Of A PPl1".;IT OOLS h0T PRCSI"dE TO �
<br /> -� � GIVC AUT11pf:ITY TO VIOLAI"E O(1 CANCCL 111C P.iiCVl.il�]'::: OF �
<br /> ANY O�IIf.P. ::'•'F UP IOC,V. L:t^. �CGVL.ITI�JGGJi\.'>iil;CilOV I
<br /> 1_ _ ORTI�CfI� U11'df.t:CECfC(�:SIitVCiIO�Y. �'
<br /> SVG'fOTAL �
<br /> renr.�i1 s �— �
<br /> TOTAL FEE 5 ~- �
<br /> ) �rc �� - Gf1�i-----�
<br /> '-'i'Y li$$ BELOS'1 TE1IS LINE sic n un�C��._;tacmno�i:,ui��.nr,u+� .�:.��
<br /> EYAflOSEi34CK .,iRLCTStT6AC1: H[AfiYAIIDS['@ACI: �LAN 'l1eCGnU:.:dLLf1 PLANCHLCKPEE
<br /> ' FEL RECEIPT ND. �
<br /> sZONE LOTAfiEA VACANTSIT@ ' �
<br /> � � ❑Y[5 ❑NO FBCS VALUATION FEE i
<br /> �:. Of' CO�'S�. OCCUPlJJCY G(IOUI' Up"],- OR'LLIU�(: ( �
<br /> .: UF ULOG NO.UF SiONICS �L\X. OCC. LOAO ❑UILUING S '�
<br /> I
<br /> _ '_-1
<br /> PLV`.1�INC: � I
<br /> .6 ZONE UAS!\1lNT I iI1t5PRINRL@It5 �
<br /> � flCUV�(lE�
<br /> []VES ❑NO h1FC11AtlICAI 1 �
<br /> I
<br /> CtALCOKOiTIONSr ' OTN[R � I
<br /> I
<br /> T
<br /> PENCLTY SCQ�O](el - � �
<br /> TOTAL j �
<br /> ' � �
<br /> ri.nr.v r vni iunriori
<br /> 1 ��n,:�.:. r:u�,�i.i�i : v :unnri�.> uu nii^^rncn nu�, ic rnur� rrnn�.ir
<br /> - !
<br /> �
<br /> �,i.-ii�.c�eiurii:ri r�nr,�.mi.�unr. errr,�rviu�udi:�Tna iur
<br /> "T_""_�'__„' ' .,
<br /> I
<br />
|