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APPLICATIOS� FOR CONSTRUCTIuN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: GAS O ELECTRIC ❑ <br />BUILDING DEPARTMENT ' <br />259�8810 <br />I i DEMOLITION I I COMBINATION i BUILDING I I MECHANICAL Il PIUMBING f 1 SIGN <br />OWNEP M/.4MDPE55 LItY ZIP PMOME' <br />. . _ . �i u� ACACJJ'J <br />tltY <br />A�CtlI1fC1M0051GNU1 ��RAD�f1E55 GiV l�r <br />Dy,�y,/ n�Yi/n rs i o2 ,�rwrr ^�� EveaEzr �✓A l'020/ aoa a5r3�6/ <br />Gf�+EMLGOM11UC1W1 MAK�ODNE55 GLY 2iP PIpNE 5 tELICENSE <br />Y� , <br />M[CII�NICK ON1MClOR MAK�OOP[55 CIIV ZIP PWNE SULELILENSE/ <br />PWMNIN]CWtP1CiW M�M1Ap011E55 CItY IIp PIqNE St�lEllG[NSE• <br />I I NEW � I ADOITION <br />IEGµ D[SCrnvv.m w rnm�� <br />ior e�ocn <br />FOR OFFICE USE ONLY: <br />fpq115E10AL6 PEMiSEi <br />USF20�[ lOtAlif� <br />rvnar <br />&SF CF <br />pT <br />W1�ME BY <br />', pEPAIR I I OEMOLITION I I WOODSiOVE/FRPLINSERT I I BUILDINGRELOCATION <br />CONtI.LTPEN50NAMryYNO'�E1q <br />v �._.� .,.._ � .�... K.�c.rf nrv�c�fA./ n2c�/i�c.' <br />� <br />���4-?��oLd�Cr <br />Mo a <br />ass- s�a i <br />I MEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS <br />qPPLICAiION AND NNOW THE SAME TO BE TRUE AND CORRECT. PLL <br />PflOVI510NS OF LAWS AND OflDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WNETFIER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />O1HER STA1E OR LOCAL LAW REGULA7ING CONSTflUCT10N OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I pM AUTHOR2ED BY TME <br />OWNER OF 5 P PERiV TO PERFORM THE WORK FOR WHICH <br />APPLICA ON IS AO AND I COMPLV WITH TME STATE <br />LONTP TORSLA IB27 WAND296200WAC. <br />x � <br />sonnivrt w' <br />BUIL�ING <br />PLUMBING <br />MEGNRNIG�L <br />RDDITION�LPUNCNEGK <br />SPRINNLEN <br />STRE BUILDING SUPL/URGE <br />PUBIIC WONRS <br />TOT�L <br />iEE <br />J <br />a69 ;aa- <br />