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APPLICATIQ ] FOR CONSTRUCT' )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ,ELECTRIC _CJ � <br /> 259-8810 <br /> ❑ DEMOLITION I_1 COMBINATION CI BUILDING Ci MECHANICl�L LJ PLUMBING ❑ SIGN <br /> �,.,�,CO ��, ��:p 5—ppE S � <O ZIP PHONE <br /> 11,�DA ll...�- /� ���3 �339-�,/7/� <br /> ���.i,r S1StLi/ 7 <br /> ��iE i � MAILA�OFESS <br /> �OF�ESIG�N�/�ADOflE55 ������/��� J Zln 4�NE <br /> GENEBALCp1iP�L10fl/ uq�A00flE55 UIY 21P �IbNE SUIEIICENSE♦ <br /> /Z/MU / — <br /> MELHIJlC�LGp1iP�CiOF MA�IAOOPE55 LIiV IiP PHONE SiAtEIILENSE� <br /> PWMBINGCp1iPAC10F M�ILADORESS CItV ZIP G1qNE SGiSLICEN$E• <br /> CONipALi PPILE Oi KORN <br /> OESGflIBE KpIN ANp$OURNElCOIAGE INVIXVED CIXitALi PERSGN Ni0 PMONE IA <br /> / <br /> _ I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED TIiIS <br /> anoroseouse wemio�nc APPLICATION AND KNOW iHE SAME TO 2E TRUE ANO COFRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TVPE OF <br /> i[caocscniv+ro�+o�rnorearv�s�ovmenowoannno�iwocov�es� WORH WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OB <br /> tlO7'.THE GRANTING OF A PERMIT DOES NOT PRESUME TO CIVE <br /> iot r �aice; K-- cpr — qUTHORITV TO ViOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �Q 2 d ( 1 S 2�� 7000�__ OTHER STATE OR LOCAI LAW flEGULATING CONSTRUCTION OR THE <br /> PEHFOFMANCE OF C0115TROCTION.THAT I AM AUTFIORIZED BY THE <br /> OWNEF OF THIS PROPERTV TO PERFOFiM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH fHE STATE <br /> ceacci ux i o Huuesa CONTRACTORS LAW 1827 FCW AP!D 296300 YlAC <br /> � <br /> CpIS(FULiKK:IOFNIEN�EP.RODfl[SS,iEIEPNUNENUM9FF �v" ,p/ �1�I �,. <br /> �� ��_T�Y ��✓��L W" t _ <br /> Pfl ECTAODflESL' � sra�� i � o.¢ — <br /> an x�si+�ssiK�v;�:m <br /> PLUMBING MECMRNICRL <br /> N0. TYPE OF FlXTUHE OP ITEM FEE NO. TYPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILET) NC—AMPIDLG UMIT$—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY�WASHBASRI� UNITHEAlERS—B.LU. M <br /> SHOWER CLOTMESDRVERS <br /> KITCNEN SINK 6 OISP VENTILATION FAN � <br /> �T <br /> DISHWAS4ER RANGE HOOD <br /> LAUNDRY TRAV WATEH HF.FTER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE�WOOD BUFNING) <br /> DFINNIN6 FOUNTAIN FIREPIACE INSERT <br /> FLOOR DRAIN NEAT PUMP <br /> BACKFIOW PREVENTERS GAS PIPING _ <br /> ROOF DRAIN�RAINLEADERS E%MAUST FAN <br /> SINK jSERVICE—BAR.ETQ) <br /> SUBTOTAL $ SUBTOTHL S <br /> PERMIT $ PEfiM1T $ <br /> TOTALFEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FflONiSEiBACI( PE�NSRBACM SIDESEiBIAN PUMC�IECNNlIMO fEE AEf.flP•NO <br /> 2 <br /> usezone �ornnen wcnrvrsne F S VqLUA7ION FEE <br /> ❑ VES ', i NO . BI:IL�ING <br /> nxorcoxsr rroorstoniEs a.rr.x, wncwwrcun�s <br /> L9°j° PLUMBMG <br /> SQEOFBLDG FIPESPPiN[LENSRE00 MSEMENt MECHANICAL <br /> n ves ❑ No <br /> OCCUPANGvmeo P:9EAunNReoo nEieniUurtnnON pODIT10NPLPUNCHELK <br /> OTHER <br /> REASON <br /> SipTE BUI:DING SUflCMFflGE <br /> IMi/J(EBY RANS�PPfqVEUBY CITYOFEYEHE7T PUB�ICY/ORNS <br /> LOCIIL SIILES <br /> DALE TAX CODE IS 31OS rOT�L <br /> -- ' - <br /> -_ . _ ._. . ._... -� <br />