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In{ L� I� L� UU � ': <br /> �►PPLICATION� FCi_: �� JUN 251987 �� <br /> �:a°�"' CONSTRUCTION <br /> eve.rett _._............................................. . <br /> FiUIL01NGDEPARTMENT PERMIT CP b11�Wo�E�pt. <br /> Z6y,A�qS TO BE COMPLETED IN INK• PLEASE PRINT <br /> � 60 / / <br /> � DEMI)LITION ❑COMBINATION ❑ BUILDIN(3 fTMECHANICAL �PI.UMBING� ❑ SION <br /> �� cm nv WJNE <br /> M�IL�ODRE39 . �. �'-t S. . � ` �I') /�/ _�� <br /> �i�i�Y'r�'t • 1�4 k'k Il` I'� 1'1I L� U.� . ."� Il`i l� I U kC I_s(�t , ,( (� I �`� � rr�u� <br /> q�ryR��T pR DEl�ONEP <br /> M�II�D�NE9! LIfV 1'i PNONE <br /> OENEMICOMTR�CIOA M�IL�DOBE59 <br /> LIfY ZIP ONONE LIGEMBE• <br /> Cin. ZIP P��ONE 4CEHSE• <br /> MELNb11G�L1'ONiR�GTOq MSR�D�RESS �J I <br /> � ,r... ,, ��, 1= ;� r «o , , n�.,�cccct-� �:,�?-��/��� �,��1_IakC���K� <br /> IL1�}7-t�a'NL (�il `� � c�t��r ���,' _ �_� �< <� r^�t r.� - <br /> � RVM�IMGGON14�CiOA <br /> M�IL�DOPE93 Glf'� IIP PIIONE IIGENEE• <br /> ������: <br /> CL�6�OfW04K �ALTER�TION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/1RPL.INSERT ❑ BUILDINO AELOCATION <br /> ❑ NEW ❑ ADDI710N <br /> VAlWTi9N Oi WORK ICCST OF M�IERI�L9�IUS L�BOAI <br /> �.��.��. � � - ' �I �(� c", ( Y���'�' �' /��Crf a� <br /> � �s-1+��1 �C�,tXi` r'>I1l .. � ( A Ki< c <br /> u�[w�wioiwo I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br /> /l�.�i�� r (' � PUCATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALI <br /> lE0KOE8CAiPTbMOFFROVEATYISMOWNBELOWOR�T��GNFOURCOPiE81 pROVISIONSOFLAWSANDORDINANCES(iOVERNIN6THI3TVPE <br /> OF WORK WILL BE COMPIETED WITH WMETNEF SF'ECIFIED HERE• <br /> �oT_s�aw—oF IN OR NOT.THE GRANTIN�OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEI THE PFOVISIONS O� <br /> ANY OTHER STATE OR LOCAI LAW REOULATINOCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIONIITURE OF CONTR�CTOR OR�UTNOA�ZED�OENT OATE <br /> X l�'�O L ('L���C_� n�Cf_L C9- C-� �� <br /> �PPUCANTB CIIY BUSINESB LIGENSE HO. <br /> MOIECT�DO�E!! � <br /> � <br /> M�INO MECMIINICAL <br /> fE[ NO. T'iE OF EOUI►MfNT _�� <br /> �p TTE O/FItTU�E I <br /> W�TER CLOBET TOILE ��N GOND.UNITS-N.P.EA I <br /> FEFRIOER�TION UNITS-M.P.EA <br /> MTMTUB BOILERS--M.P.Eil , ' <br /> UV�TORV W�SH 8�91 pA5 FIRED AC.UNI75-TONNA�E EA � <br /> SHOWER FOPCED AIR SYSiEMS-B.T.U. M EA C Cbt �� <br /> KITCHEN SINK L DISP. WALI HEATER9-B.T.U. M <br /> DI9MWASMER UNITHE�TERS-B.T.U. M <br /> UUNOR�TR�Y EVAPOMTIVE COOLERS <br /> CLOTHEB WABHEA CLOTHES DPVERS <br /> W�TER HEATER yENTILAiION F�N <br /> URINIIL qANOE HOOD . <br /> � ORINKINO FOUNTAIN A�R N�NDLING UNIT- C.F.M._ <br /> FLOOR DR�IH STOVE <br /> ' VACUUM BREAKERS MEiAL FIREPUCE 8 CMIMNEV <br /> � ROOF DM�NB-PMHIE�DER3 �ypODSTOVE/FIREPL CE INSERT <br /> SINK 9ERVICE-BA ETC. <br /> 6U!T0T11L � <br /> !U!TOT11L pE11MIT � <br /> PEIIMIT � TOTAIfEE � <br /> TOTl1l FEE � '' ' <br /> ` THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> � � RE�R SETB�CN S�DE SETB�CN PUN GHECN NUMBER <br /> PL�N CHEGK FEE <br /> i110NT8ETB�G1( FEE RECEIPTNO. <br /> � LOT�PE� V�G�Ni511E FEE� VAIWTIDN �EE <br /> UlE20NE <br /> OYE6 Ov0 <br /> OCGU �NGYGROUP NO.OF�WELUNOUNITB <br /> T'vE OF GONBT. P <br /> 3 BUILDIN� s <br /> � 6REOF9lD0. NO.OFSi0RIE9 M�%�W.LO�O <br /> PLUMBIN� <br /> �)1 MEGMANIL�I <br /> j FIRE PRINKLERS REOUIRED O VES O NO OTHER <br /> 1 <br /> � PENAL7Y <br /> � MPLICATION�GG.BY PL�NB LHECKEO BV �PPR.iOR i69U�NCE BY TOT�I <br /> � ' <br /> ... . .. i ..1., ti".:. .• <br /> t . . -�. ... ,� .(�".I -.. � � ..,.� . ... . � <br /> - I..• <br />