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� sPPLICAT�aN F�l.�' ' <br /> 1��Everprsen C O N S T R U C Y I O N everetl I <br /> LITY OF <br /> ev�r. ett RERMIT � <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATIOP! H�BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OIYNEli MNILAOORESS CIIY ZIP PIIUfIE <br /> �A �h-tut o�c �G�LL.� .•zh �. �� c� �r�N �/Ss�a.��/ 3 �" -�a z � <br /> nRC11C[f,iORDE5IGN M11qLA0DRL5ti f,liY IIP PIIOIIL <br /> GENERAIGONTPd::Ofl IARILRODPE55 Cli� 21P PI�ONE LICE1lSE� <br /> ���cal�l� ��a-c, �? �,�'-1 ��.��S.P� SfaJ � c LE'C�y'7- `f�'�o�� 3 S3-G�:1�?%i7�1�i1�,1 Z2'��: <br /> MkC11ANIf.AI COI!lRAC�Op Alnll. �OP[SS CpV 21P NIIOIIE �ICE1lSC• <br /> PWRIB�KGCONiMCTOfl I.UILAOUP[SS Cltt 21P Pu0�1[ IICBlSC� <br /> C1a55 OF WOflN I <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOI.I710N ❑ WOODSTOVE/FflPL.INSERT ❑ OUILDING RELOCP�iOf! <br /> VALUnPJNOfWORHILO iOF1.lA1CBAL5PW5U00R1 (� ��E1 ...� 'S. �G <br /> �� i:. (.t, F_�c P � • -P (2 5�.�-�• _— <br /> oe;cniu�wonn <br /> �O tA e- <br /> USE OF BIIILDING <br /> I HEREBY C[RTIFY Tf'tiT I HAVE READ AND EXAMINED TI�IIS AP� <br /> PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT.ALL <br /> 1.[GALOESCPIPTIONOFPqOPEFiY�S��OWN�EIOWOflA1�tAC11F0UqCOPIESI pROVISIONSOFlAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WI IC-THEA SPECIFIED HEflG• <br /> wr�_eic��—or ��� �–UPr 1 - � � � INORNOT.TFIEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION3 OF <br /> ANYOTHFR STATC-OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR�T/IjE-P RFORMANCE OF CONSTFlUCTION. <br /> — slCjNaTUflE ONTRAC70RORAUTlIORIZEDAGENT DAi[ <br /> / -� %�%i <br /> PROJECTAOOPE55 APPLICANTSCIIYUOSMESSLICLNSENO '- / <br /> ��33- /5i�`�2< <J' � ,J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCLOSET�TOILET) _ I O_O AIRCONQUNIiS-N.P.EA. _ <br /> I BATMTUB U REFRIGERATION UNITS-HP.EA. <br /> ._�__ ____-___ - _ <br /> LAVATORY�WASH BASIN� l O� DOILERS-H.P. EA. <br /> � SHOWER GAS FIREO A.C. UNITS-TOM1'7AGE EA <br /> HITCHEN SINK 8 OISP. L'rj _'_ FORCED AIR SYSi EMS-B.T U. h1 EA UO <br /> � OISNWASHER (� WALLHEATERS-B.T.U. M <br /> LAUN�RYTRAY UNIiHEFTERS-B.T.U. M <br /> _� CLOTHES WASHeR EVAPORATIVE GOOLEPS <br /> _ ATER HEATER — � CLO7HES DRYERS �O SC7 <br /> � URINAL ,,,� VENTILATION FAN I 00 <br /> DRINKING FOUNTAIN RANGE HOOD �� <br /> FLOOR DRAIN AIR HANOLING UNIT- QEM. <br /> VACUUId BREAKERS STOVE <br /> ROOF OHnINS-flAINLEADERS METAL FlREPLACE 8 CHIMNEV <br /> SINN(SERVICE-B4R,ETf,. WOODSTOVE/FIREPLACE INSERT �r <br /> �`- !!.[ ��� L2,L <br /> —__LL_1/ <br /> SUD TOTAL .S -- `C� SUB TOTAL 5 �}� EX� <br /> PENMIT 5 � PENMIT S <br /> TOTALFEE 5 TOTALFEE 5 <br /> THIS PORTION TO QE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iPONiSEIB4CN BEnRSET�nCK 516ESEIDACN VLnNG11ECNNOMOEB PLANCUECHFL[ <br /> �o' a v � � �o'0�,�.u��W� "�' �,3 — c�l(p �E�� � ,�.�,� r�E�� � y,nL y(O <br /> USEZOrvE IOTAR[� L' `C V <br /> Vn Ni51iE FEES VALUATION FEE <br /> �� I ,��' Y:oK i �I� ?JO ES ONO - <br /> TYPEOFCONSi , OCCUPnNCVGRDIIP NO.OFOWELIINGtINITS �J(���_ <br /> � t�'•.i � <br /> � � oui�oinc s (�+5�.`� �8� <br /> 5¢E OF OIOG NO OF SLOIU�E/g NN%.00G LOBD / <br /> �7��� Y p��i � /v' PLll1A�ING �/����5�'� <br /> MECHANICFL L ��� <br /> FIRE SPRINKLERS FEOUIRED O YES ❑ NO <br /> OTIIER � .% � <br /> — /✓'�C�- <br /> PENFLTY � �,(l'J Ol7 <br /> APPIICATION ALC BY Pl�N5C11ECNE0 BY APPR FOR ISStIANCE BV - - <br /> TOTAL ( �C( �� <br /> 5-� �; L - L <br />