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APPLICATIq 1 FOR CONSTRUCTi 1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SVSTEM: ❑ GAS O ELECTRIC `� _N o N � <br />BUILDING DEPARTMENT — <br />259�8810 <br />I I DEMOL?TION I l COMBINATION X BUILDING I i MECHANICAL R' PLUMBING !.J SIGN <br />onmrn tuc nnoncss un zm �rove <br />Geqp�e Do��,\0.N\0\ '[a2o NJK��Tto S�vO. VJ�IttiIT� Wp. q82�3 363'll�l <br />rtw�m unnmmess cirv zm v«a�c <br />!1 A <br />APU�ItfCI0NpE5'GNER M�R!DCRf55 CIiY ZIV YUONE <br />�.�Q�NE c�SZ4M 0.�nlrS. 5a�� N. �i��N. 10RC'�9 SflATZL�,W�, ��133 (706�3fe2'S02S <br />c[vEnnicoHin+cion uni�iooncss crtv zw r�wvE st�mtceHs[. <br />O`+� ��R <br />A�E01WIf,AlCJN114C1W AURI�OORG55 Llry jIP F1qNE SIAiELCGN>E• <br />NI� <br />f'LUYBINuCUIiPACiOP Y14AOOi1ES5 CI1V ZIP G1qNG S1AIELICLNSE• <br />o�+NeR <br />ca+rN�cr rnce �r wvFK <br />� �t,000,— /j:���� <br />OCSCPIBE WOflM �NDSCUARE i�UGE INVOLVED C04i�G1 FENSCN NI� PIqNE NO <br />'1y0 S4 F� <br />�qOPoSEp USE OL BOM1�iNG <br />C- C 1. A G-L <br />iEcu oEsrniarrorv or vaooi <br />l0i BICCN <br />nencat�xio iwuocn <br />H\'IU -UOV- p <br />C0115��WC1qN 10�N lENOEA <br />�MtiR���N hPi: <br />PN�JECTAD�PESS <br />L�tO MVK\�Scc <br />PLUMBING <br />NO. TYPE[ <br />WATER LLOSE <br />BAIHTUB <br />� LAVATORVIWP <br />SHOWER <br />ROOF <br />��` 1. �"C A:1��-o G ARA <br />� <br />'L -OUO � <br />1DAESS.iElEFHOi <br />��. &�H� <br />0.�Vo <br />FOR OFFICE USE ONLY: <br />rnaus'o�ca� nuesr e�c./ F <br />�,S �'Pf <br />OSEvIp1E IOIARE� <br />r_ _� <br />lttt q CON51 NO Of SIOR26 <br />��� <br />SIZGC�PIDG IIPESFflMMLEP5flE0 <br />�o Sf � <br />MNPNILVlWO iIRE.LLAPMIIWD <br />NA � <br />�EASCw <br />MIMlBY RI.NS�PFPOVC��Y <br />i �,.,� J� �� . <br />353-1'+- <br />DE SEiOKK � <br />7 S <br />1GANi51R <br />7 YES �' NO <br />;nq. unw.lwwirv�� <br />I' <br />lt4ENi <br />YES j�NO <br />GL.¢A�-o pcu�AR���pE 3S3-ll <br />i HEflEBY CERTIFV THAT I HAVL READ ANU E%AMINED THI$ <br />APPLICATION AND KNOW THE $AME TO B[ TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEHNING iN15 NPE OF <br />WORK WILL BE COMPLETED WIiH 14METHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PLRMIT DOES NOT PRESUME TO 61VE <br />Al1THORITV TO VIOLATE OR CANCEL THE PRDVISIONS OF ANV <br />OTMER STATE OP. LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF WNSTflUCTION, THAT I AM AUTNORRED BY THE <br />OWNEfl OF THIS PROPEFTY TO PERFORM THE \YORK FOR \YHICN <br />APPLICATION IS MAOE AND I COMPLY \YITN THE STATE <br />CONTRACTORS LAW /827 RC W AND 29G200 WAC <br />�X ���,�J •z -1'L - 9 3 <br />. . .,���„ n.¢ <br />FAN <br />GAS PIPIN6 <br />BWIDMG <br />PWMORIG <br />M[CHANiLAL <br />ADpITIONAI PUN GHECK <br />Ot11ER <br />SiRiE DUILDiNG SURCHRRGE <br />PUBUC WORkS <br />TOT�I <br />T U. <br />�= � <br />