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{' <br /> APPLICATIO�! FOR P"ECHAi?ICAL PERI+IIT <br /> ( �o be filled in completely by applicant) <br /> ,-, DATE ���7/�7(r <br /> PJAhiE (O�rner) � � , � ) �, �� ,,,•--,�- ; � PHGtIE IdL'IdEER <br /> CO(r'TRPCTO �. � �, �� �7 �jJ���v ) PHOPIE �'U�'BER .��-i��/ l/ <br /> � �;1 3 -C��3- <br /> ADDRESS ` . ), -�z e4'�- <��'fl' l�,Z� <<' lCE�1SE P�Ut'RF.R i�ic•r_,c-? r1 ,�(r v r , <br /> � J� <br /> TO QO WORK P,T THE FOLLOI��ING ADDRESS 1/?-�(i � / �� <br /> �' ;'�C7 t��' <br /> ���1���� _ _ <br /> USE OF BUILDIPlG Gfi!eo-� C1Addition J� teration �Repair <br /> DESCFIBE IdORK _ QOit p Platural Gas LPG Electric <br /> •eeeeeaxaseeseseeevss:=aesat��ses_ezs�evae zeazeseesue�ie:¢sseee¢cesesssc• as s�eew <br /> Sq. Ft. in Building PEFMIT FEES <br /> ?lote: Fuel piping is not included in this �o. TYPE OF E�UIPt4ENT FEE <br /> permit. Forced Fir Systems / <br /> Application accepted Plans Checked B.t.u. K.1•'. (z/ <br /> by �y - '�_ <br /> Floor Furnaces <br /> EtiILDING PERhtIT N B.t.u. Y..I! <br /> I HEREBY CERTIFY THAT I I;AVE READ P,IVD <br /> EX/,PiINED TNIS APPLICATIO�! FND K�lOI' THE i!all Heators <br /> SAI�iE TO BE TRUE AP�D CORRECT. ALL PRO- E.t.u. Y..4.'. <br /> VISIONS OF LP,4! P.P;D OP,DII!ANCES COVERING <br /> THIS TYPE OF 4!ORK 4'ILL BE COVfPLIED I�ITH Ur.it Neators <br /> u'HETHEP, SPECIFIED HEREIP! OR MOT. TNE Gt.u. K.l!. <br /> GRANTING Qf F PERFiIT UOES NQT PRESUPSE TO <br /> GIVE NUTHORITY TO VIOLATE CR CAP:�EL THE Range Hood(Commercial ) <br /> PROVISIONS OF ANY OTHER STR,TE OR LOCAL <br /> LA41 REGULP.TIP!G CONSTRUCTICiI OR THE PER-- <br /> FORN �GF, OF COIdSTRyCTIQM. Fire Sprinkler Systems <br /> � l� Fuel Storaae TRn6.� <br /> i'ii'/a�/L•ll7�c'. _<<`� T)" /� <br /> c C" Size in Gallons <br /> ronature o ontractor or ut orized i <br /> �.aent Roof Units <br /> Q.t.u. Y,.4�. <br /> Signature of O�vner UATE <br /> (If orrner-builder) idisc, <br /> ----c-====---==-=-':"_-_____-�_ <br /> "'--'-----"' ' ' - ' <br /> PEr�uT .�,�"� <br /> Permit q —�c� <br />