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APPLICATIO.. FOR CONSTRUCT� )N PERMIT °"�"'" <br /> , TO BE COMPLETED IN INK—PLEASE PRINT � <br /> .. �� or fi.c� , <br /> eVere• L . �. �il HEATINGSVSTEM: �. GAS �JELECTRIC J_________ - _ I'�, <br /> BUILDING GqPflATMENT"" ; , —" <br /> 259-8810 �,,; ' „ '.: ; , ,... <br /> DEMOLITION COMBINATION BUILDING �iAECHANICAL ,�PLUMBING SIGN <br /> On^�EA ��AiIaDDRE55 Gir ]iP��� PNOnE <br /> rxrivi �`-I Cnililli, l 2'il�i �:I,t�;v"r' Flvi. �U�rr'-t7"j�' ��� '",�2"7� <br /> iENnNT FIRiLA0DRE55 Crtv 2�P �110NE <br /> �aCwTECTORDES�GNEN M�iL�ODRE55 C�T� Z�� PNONE <br /> G[NERALCONTRACiOR MPI�AODRE55 WT� ZIP PNONE UCCNSE• <br /> l /��AIiC`sl' �ll� ��711_��. �'Iifi�P.l-�' �yZ1)� �r7�1`>�=5� /l/U6={�tLCI�(L/3�� �_ <br /> A�ECH/ANICALCONLRALi04 MAILADDRE$$ C�1� ZiP ���00.E L�CE�bE• <br /> �i r�i ��/L��'��i <br /> L�� L� y fWMBINGCOHTi1FCiOF M�ILADOAE55 ��T� ZiP �'IICKE IiCENSE• <br /> o� m `�1 �1�J <br /> Ca y y cussovvronrc � <br /> C'� NEW ADDITION V'ALTERAiION REPAIR DEMOLITION WOODSTOVEiFRPL INSERT BUILDING RELOCATION <br /> �. )� / � CONiRC f OEASON A�/ND PNONE ND <br /> � y � CONiR�Ci PNiCE OF WORp�t• ��' (J � t ,i 11C1.l Zl� "1..�•�C�� <br /> � � � OESCB�BFWOF�K n(N� O� 50U��Ef00iRGE MVOLVED ( ,f _ <br /> Vl H 1 �J l. �i\;{ l •. ' � l ' �-��� r'J-'�:j I <br /> 5 x PROPOSEOUSEJFBI��I�iNG I HEREBY CERTIFY THAT I HAVE (iEAD ANO E%AMINED THIS <br /> C�7 Q � ." / � r . �.�;) ���_ APPLICATION AND KNOW THE$AME TO BE TqUE AND COARECT. ALL <br /> H PqOVISIONS OF LAW$AND ORDINANCES GOVERNING THIS 7VPE OF <br /> p� � C decn�De ivnor�o aoaesrv,s�aw a=_�ow nrrncHFouacowEsi �yORK WILL BE COMPLETED WITH WHE7HER SPECIPIED HEREIN OA <br /> H [i1 p �o* e�ocK or _ NOT. THE GRANTWG OF A PERMiT DOES NOT PRESUME TO GIVE <br /> G1� CC'D, pl I �) -1 AUTHORITV TO VIOLATE OR CANCEL THE PqOVI$IONS OF AN� <br /> Z H 3 `�����--}��^(7' ���A: � -L)LCJ L- pERfOFlMANCB OF OCONSTFl1CT ON TMA7 AM AUTHORIZED BV THE <br /> aHC+1 <br /> C' H y OWNER OF 7H15 PROPERTV TO PERFORl.1 THE WORK FOR �VHICH <br /> �� APP�ICAiION IS MADE AND I COMPLV SNITH THE STATE <br /> H CONTHACTORSLAW iB.DRCW�KU:96.'CO WAC <br /> OCJVJ SiGhwiUREOFCONiRnLTOBORAUTVCW.f.DA�i.':r �.��E <br /> �i� r -- <br /> zHc�ii 7 jI� �� U>>L�, - tiC% <<-LJL X �(��� / }� <br /> HOUJ PFOJFLTADDFE55 ---" G���_ Ci1�L�L.L4{�.� _ _ ___. _ _ _. .. <br /> � FirPLiC4Ni5 4�r BUSItiE Si L�CENSE NO n6��.'.•.1'f.'.n..� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%iURE OR ITEM FEE NO. TYPE OF E�UIPMEN7 FEE <br /> � _ WATER CLOSET�TOILET� � AC-A HNDLG UNITS-HP. _ <br /> BATHiUB ' FORCEDAiqSv5TEh15-B.T.0 td EA <br /> � 1—� LAVATORV�WASH BASIN�_ �_ _ UNIT HEATERS-8 T.0 A1 __ � - <br /> � SHOWER CIOTHESDRYEFS <br /> KITCH[N SINK 8 DISP � VENTILATION FAN '. <br /> r— <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRY TRAV �_ VlA7ER HEATER <br /> �� �� CLOTHES WASHFR WOOD STOVE <br /> URINAL 1dE7AL FIREFLACE 8 CHIMNEV <br /> IDRINKING FOIJNTAIN__. _ FIREPLACE INSEFT _ ' <br /> � PLOCR DFAIN � nEA7 PUMP <br /> i ' 1 1 BACKFLOW PREVENTERS -�— � GAS PIPING - <br /> ROOF DRAINS-RA�NLEA�ERS E%HAUST FAN <br /> SINK�SERVICE-�AR,ETC.1 <br /> --r—— <br /> I ., �� - —__.-_ — , — <br /> I I LI — SJBTOTAL S ' _ --- —__ SUk11UTAL _5 S �C�'_— <br /> 1 PERMIT S PERMIT 5 /J <br /> TO7AL FEE 5 TOTAL FEE 5 S� '` <br /> FOR OFFICE USE ONLY: <br /> �RONi�E10AGK REaRSEip<CN 90ESEiBACN PLnNCMELKNUMpEA FEE RECEIOiNO <br /> ����y <br /> usezorve '�cr+Nen wc>H*saE FEES VALUATION fEE <br /> BUIL011JG <br /> t�'PtOFLONiSAtIOWABIE ivPEOf[ONS1AOli0. o[w��r.+ xomtrx�����c�v's — — , �— <br /> cnDoe P�UM91NG <br /> S4EOFBLDG NOOFS�ONiES O�SEMENT MECHANICAL <br /> �S <br /> OCCUPANCVLOAO �iAESPiiNatEFSREO� HBGNtU�iiATiON A�DITIO��ALPLANCNECK <br /> OiHER <br /> REASON f]R SPFiNKLERS — —�— <br /> STATE BUILDING SUFCHARGE <br /> INUNEOY GUNSAGPROVEO�� CITYOfEVERE7T PUBI,ICWORNS <br /> LOCALSALES <br /> TAX COUE IS 3105 TOTA� �s� �,�� <br />