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�'PLICATION FOR� <br />'"'E�°"'" CONSTRUCTION <br />cm or <br />evf:rett PERMIT <br />BUILDINGDEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br />269•8810 <br />n oEiuou710N ❑ COMBINATION f� BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />��«<n <br />e <br />❑ SIGN <br />� <br />FLUM9ING LONTRAGIOR M�II �DU�ESS Gi1V IIP PIIONE LiCENSE • <br />CUSd Of WOA• <br />❑ NEW ❑ ADDItION <br />� V�IU�/TION OF W ORK ICOSi O� MI <br />� ( �� �� l "�, <br />\' DE9CRiBE WOA�� <br />�; '�1" .�I� <br />kUSE��'+ <br />r�,_a,..�_� <br />�l <br />\ PROJEGT��OHE55 <br />�� <br />�� L7��, GJ,IIv�.�- <br />PIUMBING <br />NO. TYPE OF FIXTU <br />WATER ClOSET �TOILET) <br />BATHTUB <br />UV�TORV IM�ASH BASINI <br />SHOwER <br />KITCMEN SINK a DISP. <br />DISHW�SHER <br />UUNDNY TR�V <br />FLOOR �RAIN <br />BACKFLOW PREVENTE <br />ROOF DHAINS — R��NI <br />SINK �SERVICE — BAR. <br />iRON�TSE^I9�CK <br />GN ' <br />USE 2�E <br />�` � <br />TYPE OF CONSt <br />�-M <br />SIiE OF BLDO <br />7A2 S, <br />ALTERATION ❑ AEPAIR ❑ DEMOLITION ❑ WOODSTOVE/fRPL.INSERT ❑ BUILD�NG FELOCATION <br />BU! TOTAL � <br />VERMIT = <br />70TALfEE f <br />R SET6eCK SIOE SETB�CK <br />�, s / <br />AqE� y�C�NIS�fE <br />��uO � OYES ONO <br />c� <br />:IIP�NCYGfiOUP NO.OFOWF.LUNGI <br />R- 3 � � <br />OF SLORIES M�x OGG +LO,AO <br />� ry� <br />IIELNEOOY MPR. f01i ISSU�NCF 1 <br />/VX •O�c/ <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICAYION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTfiER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />tiIGNATURE Of CONIRAC70R OIl AU7NORIZE� PGEHT OATE <br />/�/ .� <br />X i � / I. � 1 � � � �� . � . / ♦ . / / / / A/1 <br />MOCHANICAL <br />NO. T'PE OF EOUtP <br />A/C — A/HNOLG UNITS — HP. <br />REFRIGERRTION UNITS — HP. <br />BOILERS—BiU/HP. <br />QAS FIRED A.G UNITS — B T.0 <br />PORCE� AIR SYSTEMS — B,TI <br />WAIL NEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPOH�TIVE COOLERS <br />CLOTMESORYERS <br />VENTIUTION FAN <br />PANGEHO00 <br />WATER HEATER <br />WOOOSTOVE <br />MEfAL FIREPLACE d CNIMNEV <br />FIREPLACEINSERT <br />MEAT PUMP <br />OAS VIPIN(3 <br />FxNAUSTFAN <br />SUSTOTAL <br />KRMIT <br />VLAN CME N NUMBEH <br />�� iq�� <br />BUILDING <br />r�uMeiN� <br />MECHANICAL <br />OTMER <br />STATE BUILDING SURCMAHGI <br />STATEENERGYSURCMARGE <br />PUBLIC WORKS <br />TOTAL <br />n <br />M EA. <br />M <br />M <br />FEE � //�y��l I REC�T�: <br />�� � <br />� � <br />5 <br />PROPEPN 01VNER5 AfiE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS ANO RELATED EASEMENTS. <br />I <br />.,....... .,.,._ _.. .ow no.+.:,.v� . .... .. ... . ... . . _ _ . . . ' ' <br />' �r: C ' J n-^... ._...._ .. . . . . . .. q� �.. . .. .... . . _. <br />41Y.�TK..a�'� � . .\ • . . . , , ' . . . . . . ' . . . . . .. . <br />