Laserfiche WebLink
'=APPLICATION FG-at <br />rho r01 NR <br />F CONSTRUCTION <br />Cl"LITY O <br />eve,rett PERMIT <br />BUILDING DEPARTMENT 259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />GE LCONTRACIOn MAIL ADDRESS CITY ZIP PHONE LICENSE <br />YVl �PSiC'J is 9�]�Y � '�/SS GG-"sTCi2/<�'N� <br />...��u 1-1.ACTDII MAIL ADDRESS LILY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />:LASS OF WORK <br />Cl NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/F RPL.INSERT ❑ BUILDING RELOCATION <br />r <br />USE OF BUILDING <br />I HEREBY CERI,FY THAT I HAVE READ AND EXAMINED THIS AP- <br />. <br />PLICATIONAND KNOWTHE SAMETO BE TRUE AND CORRECT. ALL <br />Lin <br />PROVISIO14SOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DEB PnoN or vnorenTV is owN ocLow On An AcN roun COPIES, <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUIJE TO <br />LOT— BLOCK OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAI'J REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNA7UREOFCON7RAC70RO AUTHORIZEDAGENT DATE <br />id G, -SG� <br />fez, <br />APBCIGINTS OII y PIJalmTSS LICENSE NO. <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING _ <br />TYPE OF FIXTURE FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />WATER CLOSETITOILET) <br />AIR COND. UNITS—H.P. EA. <br />REFRIGERATION UNITS—H. P. EA. <br />BATHTUB <br />LAVATORY( VASH BASIN) <br />BOILERS—H.P. EA. <br />GAS FIRED AC. UNITS —TONNAGE EA <br />SHOWER <br />KITCHEN YANK B DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA, <br />OISHWASN'F <br />WALL HEATERS—B.T.U. M <br />LAUNDRYWAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE CCOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT— C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— RAINLEADERS <br />_ <br />METAL FIREPLACE & CHIMNEY <br />_ <br />_ <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT 3 <br />TOTAL FEE S <br />TOTAL FEE 5 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />