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r.PPLICA , tON F�Jh ��� <br /> �^�F�� ��N° CONSTRUCTIOI'�II � <br /> �,n.. <br /> eV�,'ett PERMIT , <br />{ BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRI�1T <br /> I 259•8810 <br /> ❑ DEPAOLITION O COMBINATION ❑ BUILDING ❑ MECHAhICAI.. ❑ P NU!JIBING O SIGN <br /> ue�uooness crt1v / ziv � <br /> owiiE r �� ��)� / � 7 FC-�/ ���bl. i �v��l'G/� �, <br /> �-J+<=i--b�1��L�=��7/�/�1 �� �7 �({'_�/J �ir m�rnrt �' <br /> •nLM1fEW OP bF51U�lEP <br /> MAIL AUUIIlS i C��v <br /> M�II np00E55 <br /> C�rv 2p� i��nqE ucf9iF• <br /> OlnEnetCOq�nnG�O/R '� .�/ 5 � , /%Gf.�J !� . ���� � /�^�-! . <br /> �i/ ���rfl /Y ��/`CJ//'/ CJ / L � ��� GL'l1G,lfi� �y��, i . <br /> r,�rt 20• , ' ���JNE I�t11•r:i . <br /> Gf.C1UN'ULC�INIR�f.iqq M�IL.ROO�ESS <br /> �QL�'` IiV vuaiiE l�i I.ySF . �. <br /> M�i1.aDbAE55 ���Y , <br /> PLUMB'N.COqi��'.In� I <br />�. !'I/�'�t c. ' <br />! <br /> ciiss o'ylonv � <br />' �yy ❑ ADDITIDN ❑ ALTERA710N ❑ REPAIR ❑ OGMOLRION ❑ WOODSTOVE/PRPL.INSERT BUILDING RELO A I <br />! ww�uanorwnn�.�cosiui �naiu+in�sr�us«xom �, <br /> i <br /> S I <br />' or�cnroi.wonK I <br /> 3v `r �. �/f- ,����� � — <br /> utir or nu�i.on+n ! I HEREBY' CERTIFY THAT I HAVE FEAD AND EXAMINED THIS�f <br /> ��v�� ��/4/2�p�,e %� J%Q/'u ' PLICA110NANDKNQWTHESAMETOBETRUEANDCORaECT.nL� �i <br /> /�� PROVISIONSOFLAWSANDORDINANCESOOVEFNINGTHIStvF! '. <br /> lC<3��DESLRIP11p110[OHOPU11V�a4UW�OkWWO 1 CIIfOUfiCO�IF91 <br /> ��' ` � �,L� OF WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HERF �', <br /> oi�aio �_�� S�G 3 � IN OR NOT.THE GFANTING OF A PERMIT DOES NOT PRESUME Ti ' <br /> I GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIOMS O� � <br /> // P"" ANV OTHER STA7E OR LOCAL lAW REGULATING CONSTRUCTIO' <br /> F f�� � , �� OR THE PERFORMANCE OF CONSTRUCTION. , <br />� $IGNAIURE OF CONilir1C10R O� UTHORIZF.O AGENT p4tE <br />� _ , C� 6 <br /> �"�I1 X /1 .i�/� L�/(j �CJQ <br /> II' ��%/t� "— � q ,q 1'SGIIY BUS�NE55 'l�tiE NO <br />� � qAOJEf,T 100PE55 � ` <br />�l � « ?���, �,_� (9� ��v� ` <br />!� MECHANICAL <br />� PLUMB�NG FeE <br /> FEE NO. T'PE OF EOUIPMENT <br /> NO. TYPE OF FI%TURE OR ITEM ��C_p�MN�LG UNIT� <br />� WATEA CLOSET ITOILET� <br /> HEFHIGERATION UNITS-H P.EA. <br /> BATHTUB <br /> BOILEPS-BJ.0�M P. <br /> LAVATORY�WASNBASIN) � <br /> GAS FIRED A.C.UNITS-B.T.U. <br /> SHOWEF <br /> FOflCED AIR SYSTEMS-B T.U. M EA. <br /> NITCHEN SINK A DISP. <br /> WALLHEATEFS-B.T.U. M <br />� DISHWASHER M <br /> UNIT NEATERS-B.T.U. <br /> i LAUN��7Y7PAV <br /> ClO1HE5 wAS11ER EVAPORATIVE COQLERS <br /> LLOTHESORYERS <br /> UAINAL <br /> VENTILATION FAN <br /> DRINKING FOUNT�IN ppNGE NOOO <br /> FLOOR ORAIN <br /> W ATER HEATER <br /> BACKFLOW PFEVENTERS WOODSTOVE <br /> ROOF DRAINS-�nINLE�DERS METAL FIREPLl�CE 8 CHIMNEV <br /> SINK(SERVICE-D�R.ETC 1 FIREPLACE INSERT <br /> HEAT PUMP <br /> GAS PIPING �� <br /> E%HAUSTFAN <br /> , SUBTOTAL <br /> SUBTOTAI s <br /> P[PMIT <br /> PERMIT s <br /> TOTl1l FEE <br /> TOT11l FEE f r RECEIPT NO. <br /> - PtnN CM CN NUAtOER FEE � <br /> inOqi SF�A4f.� BEAA SEI9ACK � SIUE SEt9RCN � _. �, 9 I� �^ J J�/�r�- <br /> 1` ' �'— �� ' ^' <br /> /� � I � •�; _� i�i�i � �-�`' <br /> o�a tur,� ioi nnro .. � vnr,am s e FEES <br /> VALUATION PEE <br /> '� �> h ���,r_c r> £, ures no S <br /> `�-;� BUILDING <br /> ��re or r,rnisr ncrurnncrr,nouv IID Of DWRLINGUNIIS <br /> ��N �t �_ / �- PLUM�ING <br /> S�lE oi !fi De rip V�Slo:nes uax occ loao MECHANICAL <br /> l�aasr- / N�1 <br /> OTHER <br /> FlRE SPRINHLERS f7GOUIREO ❑ YcS icy NO STATE BUILD�NG SURCHAf1GE <br /> STATE ENERGY SURCHAf1GE <br /> I <br /> �91NSC��ECNEOOY APPf1fORI55UANLEBV I <br /> arcuc<non.,[;c m PUBUC WORKS <br /> � J 1 I <br /> �, ��� TOTAL <br /> PROPERTYLOINELOCATONSANDNRELATED EASEMENTSING ALL <br />