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-"'�; "'� PLICATIOM FOR� <br />""E�°"� CO�ISTRUCTION ' <br />n-W_ �',i:%~:f�� . '•.ii': <br />�„r.�ver�ett � PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br />269•H810 <br />ereren <br />e�� <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MtCHAPiIC!1L ❑ PLUMBING ❑ SIGN <br />pWNER M�ILADOPESS GITV 11P - PHONE3Sy 9��(u <br />� .. II n�..'--. ciant �cirr.Cw AAu,t'rL%�C� SS"Z7� 2S5 R7z7 <br />c5�1tit �- - <br />OENEMICONiN�CTON M�II ��OnE55 G�fV 2iF �HON3 LICENSE • <br />�S�d�{• <br />MELH�NIC�LGONTP�CTOq MULAOONESS GIIY ZiP PNCNE LICENSE• <br />PLUMBINOCONTR�CiOP M�ILAODAESS CIfY ZiP Plli)NE IICENSE• I <br />❑ ADDITION ❑ ALTERATION ❑ HEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />�, / 7f r /�%/'�/,� dt` <br />E WORN <br />6�c�s �2�c r N� � <br />w�oi c <br />�CSiDcNF� <br />LlO�I UESGRIP�NN V� rnVrCn� � �on�nn oc <br />�o, � a�a��oF T/?A iD . <br />PLUMBIN4 <br />�/ D �- <br />BASINI <br />KITCHEN SINI( A DISP. <br />DISIIWASHER <br />UUNDRV TRAY <br />CLOTHES WASMER <br />URINAL <br />DRINKING FOUNT�tN <br />FLOOR ORAIN <br />nuur unwma - i <br />gINK ISERVICE - <br />CY� <br />Q'tSIpt/UC� <br />_ s.•vGCL 'rA�kr� <br />LO W OR AItAGH LOUR COPIESI <br />� _,2��unDe <br />G//. ,flRGE 7. $ . � <br />lUeTOTAI <br />PERMIT <br />TOTAL FEE <br />)NTSEiB�CK RE�R9ETl�CK <br />20' n1� � Gu+ �� <br />?20NE^ S LOTApE� <br />Q� <br />'EOF 0 9T ' OCCUP�NGI'GPOUP <br />R-3 <br />E OF BL06 NO OF S10PIES <br />�y;� a � <br />.4.7g s��r668sF G.�►t�. <br />)N ALC �v <br />� <br />�� ,-, - . <br />,. w�, ,+- <br />j�vES ONO <br />.� <br />NO.OF nWF.LLIN <br />J <br />:.c�. occ �aeo <br />- i✓A <br />'.IIECKEOBY APPR f011�55UANCE <br />d� �, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED Ttil3 AP• <br />PLICATION AND KNOW TNE SAMETO BETRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND OR�INANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIE� HERE• <br />IN OR NOT. THE GRANTING OF A PERMI f OOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />O THE PERFORMANCE OF CONSTRUCTION. . <br />SIG ATURE OF CONTPRCTOR ON ORIIEO AGENT OnTE <br />a-1a-�� <br />MECHANICAL <br />-NMNDIO <br />REYMIGtRn i wrv urvn a- <br />BOILERS - O.T.U./H,P. <br />GAS FIREO A.C. U.'IITS - E <br />FORCEO AIR SYSTEMS - I <br />WAIL MEATERS - B.T.U. <br />UNIT MEATERS - B.T.U. <br />EVAPORATIVECOOlERS <br />CIOTHESORYERS <br />VENTILATION FAN <br />RANGEHO00 <br />WIITER HEATER <br />METAL FIREPLACE S <br />FIREPLACEINSERT <br />SUlTOTAL <br />PlRMI7 <br />PLAN CME K NUMBER <br />538�14�; <br />BUIIDING <br />PLUMBING <br />MECHANICAL <br />OTHER I�f1 �� <br />STATE BUILDING SURCMARG <br />STATEENERGYSUHCHARGE <br />PUBUC WORKS <br />TOTAL <br />M <br />M <br />FEE RECEIPT NO. <br />yllv� 4�� <br />S <br />AROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOC.ITIONS AND RELATED EASEMENTS. <br />' i't1n•>7°' :t . _ .. . - - <br />