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<br />BUII.DING DEPARTMENT
<br />259 881C
<br />�,�'PLICATION FO(.
<br />CONSTRUCTION
<br />PE�MIT
<br />�O BE COMPLETED IN INK - PLEASE PRINT
<br />i i DEMOLITION ❑ COMBINATION JB'BUILDING O MECHANICAL ❑ PLUMBING
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<br />NFW ❑ �DDIIION ❑ ALTF.RATION ❑ RFPAIfi ❑ DEMOLIIIOh ❑ WOODSTOVE/FRP�.INSERT ❑ BUILOING RELOCAtIOn
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<br />TYPE OF FI%TURE OR ITEM
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<br />LAVAiORY IWPSM PASINI
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<br />�RINKING FOUNTAIN
<br />FLOOA DA�IN
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<br />I HERCBY CERTIFV THAT I HAVE READ AND EXAMWED THIS Ap-
<br />PLICATIONANDKNOW THE SAMF 70BE TRUE ANDCORRC�T ALL
<br />PqOVISIONSOF LAWSANDORDINANCESGOVERNIN(iTNISTVPE
<br />Of WOFM, WII.L BE COMPLETED WITN WHETNERSPECIFlED HERE�
<br />IN OR NOT THE GRANTING OF A PFRMIT DOES N01 PRESUME TO
<br />GIVE AUTHORITV TO VIOLATE OR CANCFL THE PROVISIONS OF
<br />ANV OTHER STATE OR LOCAL LAW FEGUTATINGCONSiRUCTION
<br />OR THE PERFORMANCE OF CONS7RUCYION
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<br />MECHANICAL
<br />NO. T'PF OF EOUIPMENT
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<br />REFA�CEAATION LIHITS - H P EA
<br />flOILERS - B T U �H P
<br />aA$FIRED�G UNITS-OTU
<br />FO�CED ��F $YSTEMS - B T U M FA
<br />WAI.LMEATERS-BTU M
<br />I/Nl' HEATIpRS - B T U M
<br />EVAPORnTIVF COOlERS
<br />CICTME50P.vERS
<br />VENTILRTION F�N
<br />RANGEHOOn
<br />WITER HEr1TEA
<br />WO00 STOVE
<br />METAI FIREPLAf,E 6 CMIMNE�
<br />FIREPIACE INSERT
<br />MEA� GUMP
<br />G45 PiPINfi
<br />E%H�USTF�N
<br />%AN i;H N NUMBEN
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<br />VALUATION
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<br />PLUMBING
<br />MECHANICAI.
<br />OiHEN I' �GNV I l/' I
<br />ST�TE BUILDING SUFCHARG
<br />StATEENERGVSURCHARGE
<br />PVBLIC WORNS
<br />TOTAL
<br />FEE
<br />ECE�PT NO
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<br />PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMINIIJG ALL
<br />P'70PERTV JNE LOCATIONSANO RELATED cASEMENTS
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