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�,�-.P�'LICATION FO.�' ���,�„ <br /> '".E"'°'»" CONSTRUCTIO�! O <br /> dtt OF <br /> everet� P�RMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> � DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> JWNER M�ILh�ORE55 CIIY ZIP PIIONE <br /> 1�1Gn�� �iic�'ia�G�S loDfe V�a� i ��'r,�oe Dr �=�P�P�/ r�'aa.3 �SeZ -70s� <br /> �RLMi�EGf OR pE910NEN MAIL ADOPESS CITY Z�V �NONE <br /> .ENEA�lCON1neG10B MMIAUDnC55 G�tt ZIP PNONE LILENSE• <br /> IEGUHiGLCONiReC10: M�iL�DOnE55 G�lv DP i'uONE UCCnS[• <br /> 'LUMBINOCONIP�GiON MAItADORE55 GITY 21P PI�ONE L6ENSE• <br /> :1�550F WOPN <br /> ❑ NEW ❑ ADDITION ❑ AL7EPATION ❑ REPAIR ❑ DEMOLIiIO.V � WOODSTOV�/FRPL.INSERT ❑ OUILDING RELOCATION <br /> ��LUIITION OI WOAKILOSt O!M�IERIAl9 PtU9 L�BORI <br /> �E9C �E WORK � <br /> � �re �(Q�P �"nsn�� <br /> ist ov ewiou.o I� 1 IIEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP� <br /> SIYI �P �d�WI V1O�110. PLICA?IONANDKNOW7NESAMETOBETRUEANDCOFRECT.ALI <br /> co��oe RIPiIONOFPROF RtYISNOWNB[LOWOR�ii�CN(OURGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPF <br /> OF WORK WILL BE COMPL[TED WITH WHETHER SPECIFIED HERE• <br /> or_BiocK—or_ IN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTFiER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANC'c OF CONSTRUCTION. <br /> SIGNATVA80FCONfR�CTG�ORApiMOf11ZE0�G[Nl D�1E <br /> �� -, �� �,. a9'-1 <br /> �ROJECi�00RE59 p ' �'PLC�Ni5C11V0U5iN[SSLICCN [NO <br /> InDG UiPcJ �r(-�9e J�f' <br /> 'LUMBINO MECHIINICAI <br /> NO. TrPE OF FIl(TURE FEE NO. TYPE OF EOUIPMENi FEE <br /> WATERCLOSEf 701LED AIRCOND. UNITS—H.P.EA. <br /> BAIHiUB REFRIGERATION UNIiS—H.P.EA. <br /> UVATORV(WASH OAS�N� UOILERS—HP.EA. <br /> SHOWEi1 GAS FIREO A C.UNI15—TONNAGE EA. <br /> RITCHEN SINN 8 DISP. FORCED AIR S�SiEMS—U.T.U. M EA. <br /> OISHWASNER WALLIIEAlEPS—B.T.U. M <br /> LAUNDRYTRAV UNI7NEAlEFS—B.TU. M <br /> CLOTHES WASHER EVAPORAiIVE COOLERS <br /> WATERHEATEF . CI.OTHESDRYERS <br /> URINAL VENTILATION FAN <br /> ORINKINQ FOUNTAIN R�NGE 11000 _ <br /> FLOOR DRAIN AIR I/�NOL�N6 UNIT— C.F.M, _ <br /> VACUUM BREAKERS S70Vfi <br /> ROOF�RAIIJS—RAlI1LEAUERS ME7PL FIREPLACE 6 CHIMNEY <br /> SINN�SGRVICL—BAR,ETC. P100DSTOVE/FlREPLALE INSEPT (� Q,rJ <br /> SUB TOTRL SUBTOTAL S —� <br /> PEflMIi f PERMIT f <br /> TOTALFEE S TOTALFEE 5 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �on�seie�cn n[nnseioacK smescio�cK ruHCHecK��uMoen � niAHcrrtcr.rce <br /> � P[E �EC[i�l rvD <br /> ;EIOrv[ IOT�PEA yqG�HiSitE <br /> fEES VALU�TION fEE <br /> ❑Y[5 ONO — <br /> �nLpfCOHSi OCLUPRNCYG�OUP NO.OfOWELLIN6UN115 <br /> BUILDINO i <br /> IE OF BLpO NO Of SIUnl65 Mq%.00C.lDAO <br /> PLUMBING <br /> MECNANIC4L 7 UO <br /> iqE$PRINKLERS R[OUIRED ❑YES O NO <br /> OTHER <br /> PENRITY <br /> �PLIC�IION�CC BY PL�NSCNEGNE�BY �PPR LORISSU�NCE9Y — — —' <br /> n TOiA� �� C C) <br /> � �Y' <br />