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��ti� <br />: :- �PPLICATION FO '�' <br />a �MEwrpmn �� � � �'CO:NSTR�UCTION� � <br />' aG1YOf � <br />' r.iFi'_.. � , . . . . � . , .. <br />�eVer�tt PERMIT <br />�:'�BUILDIN(3 DEPARTMENT <br />.: ;�,Y69.gg�p TO BE COMPLETED IN INK • PLEASE PRINT <br />��!O DEMOLITION � COMBINATION ❑ BUILDING �MECHANICAL <br />�:�'�`"��l�c� . ��-RiE�AD03iao M�a,���r"� B��b <br />�v <br />� �� �v <br />• ❑ PLUMBING ' ' � `'�.O'31CiN <br />r� . PHONE �� J ^ /-���`� <br />L� � �/ �N <br />' PNONE � ' ' � <br />� ' . ii�; �r: <br />PNONE lIC SE • <br />�1 _ 9�'sa�.-� . <br />�''M[CMIINIC�LCONTMGTOq. ( M�ILAOONE55 I ; �y: - �i1'� _ / _LIP_� � PNONE � ����t � <br />3 %T�J C1/? N <br />PLUMlINOCONTR�CiOP MAIL��DPE55 CIfY 21P PMO ' LICENSE� <br />.dCl � . . r i � i . . . . . . 1 ♦. . <br />C1�840F WORN <br />� ' � ❑ � NEW ❑ ADDITION �, ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFPL.INSERT ❑ BUIIDING REIOCAT10N <br />�•� VALWTIONOF WORK�COSTOF M�TENI�LS PLU9 L�BONI <br />'; � % p�il Wsr'�} �-L G�� S �U�.t6fiG�. <br />�. . <br />��ueeor uuou+o C I HEREBY CERTIFY THAT 1 HAVE FEAD AND EXAMINED THIS AP• <br />''�� �S�L%��G�i ' ' � � � ' • � PLICATIONANDKNOWTHESAM TO <br />.,�oJ—e�oc�—or_ <br />:��-: <br />tb!.:. �- : � . <br />a <br />ll�l LT�D 1��-V� <br />IDRV TRAV <br />IFS WASNER <br />A' _ . _ _. . <br />KIN.1 FOUNTAIN <br />ROOF DRAINS — RAINLEADERS <br />SINK (BERVICE — BAR, ETCJ <br />LOTAREA <br />r[L <br />VAC�NTSITE ,. <br />OYES ONO '�� <br />UNIT9 <br />�PPR.FOfl195U�NLE BY <br />E BETRUEANDCORRECT.ALL <br />PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE � <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. '. �%�` ,��! <br />SIQNAT PEO CONTRACTORORAUiNO ZED�OFNT pATE <br />x ��� r,�M.��� � —'�—� <br />•PPLIGANTS Cltt BUSINE�S UCENSE WJ <br />MECHAHICAL <br />A/C — Ml/NOL� UNITS — <br />REFRIGERATION UNITS - <br />BOILERS — B.T.U.�H.P. <br />dA5 FIRED A.C. UNITS — I <br />FOHCED AIR SYS7EM3 — <br />WALL HEA7ER5 — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />c�orries oArens <br />VENTIUTION FAN <br />RANOEHOOD <br />1':l!i�l: <br />M <br />M <br />� TOTALfE[ f� <br />PIAN CMECN NUMBER � FEE � RECEIPT NO. <br />BUILOING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUtLDING SURCHAP.GE <br />STATEENER6VSURCHAPGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMININO ALL <br />PROPERTY LINE LOCATIONS AND REUITED EASEMENTS <br />