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APPLICATIf�N FOR CONSTRUCT�ON PERMIT � <br /> TO BE f;OMPLETED IN BLACK INK—PLEASE PRiNT <br /> BUILDINGDEPARTMENT HEATINGSVSTEM: ❑GAS ❑ELECTRIC ❑ l <br /> 259�8810 <br /> ❑ DEMOLITION �COMBINATION ❑ BUILDING ❑MECMANICAL ❑PLUMBINO ❑ SIGN <br /> OWKN A44MDPF55 CItY ZiV p�qNE <br /> �P� `�7 3��1 flU�'` g S 2 . c��2�-T� u.3..� �tBZDY� w'. is�be�o <br /> 1EN41i M14�PM1fb5 L�tY EiV PIKME <br /> �ar�.c� �c�°l 3¢o A.xs Sd c.9��Rac,�-:1..�� °12sto�, <br /> �PCNREC�lO�R�DyCS_W�N��f�R j WL�DDfIE$$ C�iV � II� pl�llE <br /> 1.J1J..i-'��L- <br /> LEN[PN�L(Mf-qy.�CL1D�fl� M16/.00Rf55 CIiY tF pNy1E Sf�l[lSCNS[I <br /> t�\` <br /> M(CNANiL4CONiPKtOq MI.IMDP[55 CItY 2iP %�NE S1�tElCENS(s <br /> OI.N"�rZ <br /> RUMBMGCWiReC1011 M�LMONC55 Qtt IIV P1qNE SIqCIKENY• <br /> 4�Rf <br /> Cq11H�C�i V11iC..E�O�I WJFM <br /> �J�0 <br /> MSC�XIE Htlf1h�Np$p�J�q[fOOt�G[INVQVEO LCNi/.Ci P[fl50N ANO FIYJNE NO <br /> zS5 �� a.�Gcc�y- a� 2r+� <br /> -'r�.flDR_ <br /> I NEREBY CERTIFY TH�T I HAVE READ AND E%AMINED THIS <br /> vnoroSE�usea eunom0 APPLICATION AND KNOW TNE DAME TO�E TROE AiJD CORRECT RLL <br /> ��r?�hL PRpV1510N5 OF lAWS AND ORDIN�NCES GOVERNING TNIS TYPE OF <br /> umucescniviqvocrnw6nrv�s�wenxe�owonenncN�wncorKs� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> N0T iME GRRNTING OF A PERMIT DOES NOT PRESUME 10 GIVE <br /> �o* (���.��e_i�ocK.� /a1 /1 q AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> 'TR�T�Y� AJ Ll ) l!�l Il P�L, (Y/`V� L[T{' 4 OTHEP STATE OR LOCAL LPW REGULATING CONSTRUCTION OR THE <br /> �p q PERFORMANP�^F f,ONSTFUCT10N.THAT I AM Al1THORIZEL 9V il'. <br /> •ScC.1p TWN /.�rN 1',� �1= ��., m. �WNER f'r THIS PPAPERTY TO PERFORM THE WORK FOfl :"..,H <br /> renca*�sioH�vecn APPLICQpIOjN1 I$ MADE 4ND COMPLV WITH TME STATE <br /> CONiw`'C./ SL�W�7flCW N 296.20CWFC. <br /> Cp�51PUCiKMIIO�NIFNMP,ILp�E55 iFIEPNWENUMB[R // <br /> PPOJECT ADDRE55 U 7-('7'y 3 <br /> �� �JQ�� — .�. •� re.0�n —_ <br /> PLUMBIN6 MECHANIC�L <br /> NO. TYPI�OF FIl(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> � \VATER CLOSET(TOILET� AIC—AMNDLG UNITS—dP. <br /> EIATHTOB FORCEDAIRSYSTEMS—B.TU. M E.A. <br /> 1 LAVATOFV(WASHBASIN� +— 'L UNITMEATER$—BTU. M <br /> (L SHOWER GLOTHESDRYERS <br /> kI�CHEN SINK b DISP VENi1LATION FAN <br /> DISHWr15HER RANGEHOO� � �— <br /> LPUNORY TRAV 1VnTER HEATER <br /> C.LOTIIES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BUFNING) <br /> URINHIt!3 FOUNTFM FIREPLACE INSEPT <br /> FLOOq DRAIN M[AT PUMP <br /> fiACKFIOW PREVENTERS GAS PIPMG <br /> ROOF DRAINS—RPINLEA�ERS E)(NAUST FAN <br /> 5'VK(SERVICC—B1R.ETCJ <br /> —� <br /> SUBTOTAL 5 Sl1BTOTAL $ - <br /> PE7MIT $ PERMIT F <br /> TOTAIFEE b TOTALFEE 3 <br /> FOR OFFICE USE ONLY; <br /> ipp11fiC10ELM NE�RiEiO�CG SNfS[LNCR RANLIIELNNVMBFfl FEE PEL[I^ilq <br /> o` Zu� 5' " <br /> usetont �menu v�cwts�re FEES V1ILUATION FEF. <br /> R 'I �l UOO Y I!VES P NO oUnDiNG 1 <br /> ivnacw�� r�oors.oaiEs mv.ti. noomunc�rvm JD l,�(r � O�� <br /> ' ' � I PWMBING a <br /> 54FOF9�tG �iqES�n�+lEnSP[00 O��St�' ''� MECMANICAL ��� <br /> tj 1 0 +'YES ❑ NO _ <br /> OCCUP�N YIO�D 1�sEunRMPfO➢ nEq111lx.�rteT`pl ApDRIONALPLINC!.cCN / i��� <br /> �e_— ° 28' <br /> OiMER <br /> PEh50N — �_ <br /> STATE BW LOING SURLNAHGE �i.-'� <br /> MIANEBY IYANS�PPPWEOBY CITYOFEVFflETT PIIBLICWOPKS <br /> J M �ocu sues —� <br /> w�e-� T�l(CDOE IS 31U5 ror�� �,.^�il� w� <br />