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APPLICATIQ 1 FOR CONSTRU�;T' 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT �EATiNG SYSTEM: � GAS IJ ELECTPIC J __ � <br /> 259�8810 �G�;_ <br /> �� OEMOLITION I �COMBINATION ' � BUILDING �. �.MECHANICAL XPLUMBING I ; SIGN <br /> o�vn�n r.u�ie�oass nn I�r rrxne <br /> joN!� iJ; �� M.�,.�"Y��I"AUE sF €�tiJi�oS -5��! <br /> r/aI/L — <br /> .nc�rtccroaossax[n �u�i.n�v+�ss a�r nr r��e <br /> 1,latJL <br /> ccv�nucaaneacn u+nn[a�css a�r nr r+a� s*ercucorsc� <br /> Mf4:M.WIfKCONIPI.l1(Ni A4xI.I1ME55 Cli\ ��lY TI> PMJN[ S1�fClKFNSE♦ <br /> �iau ' ���s :,.� �]»(�AKC �.-ywr�ssq, un. YFiaf 36.vs��sJ91�v�1cl,'v�Gja <br /> �I:4nrvccoNimc cn l�JonEss crtv Si> nionE sle¢lK[Nst� <br /> s�E <br /> ca+.n�c�vn�0���- <br /> a <br /> I)[SCA�BE Wq�6�NI�5(NEPE(M�W[M\'RVfO COM1Ci PfRNMI ANOOIIGME Iq <br /> i�[.si2(1 <lcer 9�� � A�✓ -- <br /> I (SU S�• ��' — I HEREBV CERTIFV TH�T I HAVE F[�U AND EXRM1IINED TI/I$ <br /> vnoroseoos[or Bu¢Dmc pPPUCATIDN AND KNOW TME SAME TO DE TRUE ANO GORRECT.ALL <br /> ��� AflOViSiONS OF LAWS AND OiiDINANCES GOVEFNING THIS TYCL OF <br /> ucuo[scnivipHpvuorcnttis«weiac�owenn*rarnocovrts WORKWILLBECOlAPLETEDWITHWNETHERSPEqFl[DHEREiNOR <br /> NOT. TME GCANTING OF�PERhIIT DOES NOT PRESUME TO GIVE <br /> m� eiocn 0� pUTNORITY TO VIOLATE OR CANCEL TME PROVISIONS OF ANY <br /> OiHER STATE OR LOC�L LFW REGULA7ING CONSTRUCT10Y OR 7NE <br /> PERfO"ilAANCE OF CONSTIiUCT10N.THAT 1 AM AUTIIOFIZED BY THE <br /> OWNER OF TMIS PROPERTY TO PEfiFORIA THE WORK FOR WHIGH <br /> - Af'PLICFTION IS IAADE AND I COMPLY WITM iHE STnT[ <br /> rencu Lx�o Nuuore CONTRACTOFS LA�W 10 27 RG W AND.'9G20J WAC <br /> COtiStPIICiNnlO�NILNMfl.ADCAE551ttfFNGNCNV1A11f� ���/'VfJ- <br /> �,C� ,��i � I ////� __ <br /> q JEC AOD E55 <br /> � 4 f� �U�CQE� 0% _ — _ <br /> FLUMBING MELHANICAL <br /> N0. TVPEOFFI%TUPEOHITEM FEE N0. TYPEOFEOUIPMENT FEE <br /> WFTHR GLOSET ITOILCTI A C- A HH�i G UN�i S-HP __ <br /> _ BATNTU� _ � FORC[DAINSVSfBdS-B.T.U. MEA ' <br /> LAVATOFY��YASH6ASINI UNITHEA1Cfi5 ATU. M <br /> SHOW[q GIOiHE>�RV[RS <br /> NIiCMEKSiNKbD1$P ' YENTRAilOYF�N <br /> DISNIYASNER F4NGE NOOD _ <br /> LAUNUiiVTRAY �_ \YATEflMEATER _ <br /> CLOTHfES Wp$HER \5'JOO 510VE _ <br /> UHIN41. Id[IAL FlREPLAGE IWODD BURNING� <br /> ORINNING FOONTpIN RREPI.ACE INSERT <br /> FLOOR pRAIN HEAT PUtdP <br /> BACNFLOWPREVENTERS —T Gr15PIPING ' <br /> ROOFDRAINS-RAINLEADERS EXNAUSTFAN � <br /> $INN�SERVICE-�AR.ETCJ . <br /> SUB TOTAL 5 SUB TOiAL S <br /> PERMIT S PERMIT S <br /> TOTALFEE b TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> InJ6i5I1BALn P[EPSE1�nCrc S�DCSPO�LM RLNCMECNNu49[R IfE A[Rio1N0 <br /> �//,�'f� <br /> v-.E.:cws iateeu v�c�e�sne FEES VALUATION FEE <br /> . I VES I � NO gJLLOiNG <br /> i��7o'consr �.�sronrts n�+_.wm — — <br /> °"" vwuoir�c <br /> tiileO�B�W finES�nmxtCnSn[OD B/SEMIxf MECHANiCAt �7 '�I� <br /> G YES :' NO — — <br /> o[;CvrencvlWU ��aEReRUFEa9 nEqrrtLiurtliKM AODI110NALPUNCMECN <br /> OTNEP <br /> BI ASO4 <br /> S1AIC�IJILDING SUFCN�RGE <br /> i��in.,cev neHsevrarnmer CITYOFEVEflFTT aueucv:oaKs <br /> LOCRL SIIIES <br /> c.�e TAX CO�E IS 3105 ror�i � <br />