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i4 . <br />•l. :� <br />..YEwryrwn� <br />a <br />����'ever��tt <br />BUILDING C�EPARTHIENT <br />258•8810 <br />�PPLICATION FO '� <br />��OIV'STRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />MI1il I�VUN[JJ <br />_ T rJ_ n 1 <br />C_� <br />� ��. <br />❑ PLUMBING <br />everen <br />e <br />❑ SIGN <br />PIUMBINO CONLRA�LOR MAIL �DDPES$ CI1Y ZiP PIIONE LICENS[ • <br />❑ NEW ❑ ADDITION L� ALTERATION ❑ FEPAiR ❑ OEMOLITION ❑ WOODSTOVE/FqPL.INSEt7T ❑ eWu�iNr, aFinr.nnnn� <br />— c, iv.<.�,�. i� <br />LEd�I DESC'11PTION O� PqOPEF <br />..._.n-�� ��� <br />LJI—PIOG �iPS? 4ZOF_ <br />/ �3� ��t� <br />�^ <br />\ R�iOJECT�D�RE55 <br />PLUMBING <br />NO. T'PE OF FI%Tl <br />WATEF CLOSEf (TOILET� <br />BATHTUB <br />LAVATOHV�WASN B�SIN� <br />SHOWER <br />KITCHEN SINK 6 OISP. <br />OELOW OA RITACII fOUR LOPIE51 <br />UUNDPV TRRY <br />CLOTHES WASHER <br />URINAL <br />DRINNING FOUNTAIk <br />FLOOR ORAII� <br />BACKFIOW PREVENTERS <br />ROOF DRAINS — flA1NLeA0ER5 <br />SINK �SERVICE — BAR. ETC � <br />IRONTSEiBACN <br />USEION[ <br />R-s <br />TYPE 0� NS.T I <br />� N <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />RE�RSElOACN <br />l0t <br />NO <br />...� <br />S�DE SEiBACN <br />V�CANi SI1E <br />,.ES �N� <br />f.f1�0jUP NOOFOWELLINQpN115 <br />' G� � <br />I[5 MA% OCG lORO <br />� �+,ra <br />i�e� � � � G <br />1 HER[BV CERTIFY THAT I HAVE READ AND EXAMINED THIJ AP- <br />PLICATIONANDKNOWTHESf �.2TOBETRUEANDCORRECT.ALL <br />PROV�SION,i OF LAWSAND OI .JINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE� <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STA7E OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMAtJCE OF CONSTRUCTION. . <br />5' .NATURE O� CONIRACiOR OR nUiMOR1ZED AGENT pA7E . <br />X ,�/_' /1 /�/ / � , _ _ <br />NO <br />MECHANICAI <br />TYPE OF EOUIP <br />A/C — OiNNOLG UNITS — N P. <br />REPRIGERATION UNITS —N P I <br />BOILERS — B.T U /M P. <br />GAS FIRED A C UNITS — �SL. <br />FORCED AIR SYSTEMS — BSL. <br />WALL HEATEI7S — B.T U. <br />UNI? NEATEPS — B.TL. <br />EVAPORA"IVECOOLEPS <br />CLOTHESDRYERS <br />VENTIIATION FAN <br />RANGEHO00 <br />WATERNLATER <br />wOOD STOVE <br />METAL FIREPLACE 6 CNIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />Gn5 PIPINC <br />EXMAUSTFAN <br />M EA <br />M <br />M <br />SUBTOTAL <br />P[RMIT <br />TOTAI FfE <br />PLAN �NE K NUMBER fEE n <br />�1 ��,7aC� ��`� <br />BUILDING <br />PLUMOING <br />MECHANICAL <br />OTNEq <br />STATE DUILDIr�G SURCHARG <br />STATE ENEF�uY SURCNHPGE <br />PUBLIC WG9K5 <br />TOTAL <br />FEE <br />RECEIPT NO. <br />9D7�/� <br />PROPERTY OWNERS ARE RESFGNSiELE FOR DETERMINING AlL <br />PROPERN LINE LOC4TION5 hND fiElA�iED EASEMENIS. <br />