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__ �. � i <br /> ,,,PPLICATION F01. ���,�„ <br /> c��EV NI'ett CONS RM TTION 0 �, <br /> ee P <br /> BUILDING DEPARTMENT <br /> 259-BBiO TO BE COMPLCTED IN INK • PLEASE PRINT <br /> O DEMOLITION � COMBINATION [] BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> riNrltl 1.1111 �:IIlli1'.'.. li.r :�1. F�•)NI <br /> CaFan�ca ��c 1P�4 nl • 3y A. �t �t�� _ 9Nio3 Sy}-gzl3 <br /> >�. .a�ii �i�nma�..��u .n.n •�mn=v • —� o��uHi <br /> � — <br /> n•.I��ai 1 JNIPAiJ�lll M1R �flflqi:ti . �� l�P ih�pNl �R.1 N[I • <br /> ,.Siqy� �YEaA�f l�3Q.L <br /> o�i�uq��.ni %��r�ruerrnn 4�n .nnnts> G�. Pr ru,�qr iic��r.r . <br /> �'1UMPIY�r1�.C'N1114� I1111 M�II ��l1N4'.� �'1� lil 1'����.�1 Il� f�l'it • <br /> �c �rl Sewnd 1eLtF �J. C'its�.-ro ��E�tff" 9aLa��4`3953-} Pu6.Er� 1Yl �� <br /> I,�.�I�y:Sf W�1N� <br /> lL1 NEW ❑ �DDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FNPLJNSERT ❑ BUILDING RELOUIION <br /> ..ir.n��nu„� wnn. � osin� nui�mei,.i�ius'ia�an.. — - <br /> � �,r.^9 <br /> U15Cnqit wnn. '-' <br /> T�uJ 4�4 n�E �ovt s+. _ ' _ _ --- <br /> usF u� flc�im�+��. p I HER[l1V CERTIFV THAT 1 HAVE READ AND E%AMINED TI115 AP� <br /> K�Cy�d4r1c6 PLICAiIONANDKNOW iFIESAMETOBETRUEANDCORRECT ALL <br /> uo•iorscaivnnvn�nnor[nir,s�owNuf.wwoa�n�u�rouncovn,� PqOVISION50FLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> ��. OF WORK WILI BE COMPi_ETED WITH WhiETN�R SPECiFIED NEFE� <br /> ,,,, IL oi�,�„_�F �Twitl L�� U� INORNOTTH[GRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GNE AUTHORITy 70 VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANV OTHER STqT[OR LOCAL LAW REGULATINGCONSTi7UC110N <br /> OR THE PERFORMANG[ OF COHSTRUCTION <br /> til:i�:lillli! 111 l i111�11l.f:f.'�N(lll AIII11(illi��[).11.I 111 �i.t�� <br /> X U�._:,,r �1 � � �� � n i� <br /> 1'q(�II L110[)BESS •1.1`I C�N f��1�r PbMNI ti5 i TI rp.! •�� <br /> PLUMHING MECHANICAL <br /> NO. TYPE OF FI1(TUNE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> W�TER CLOSET ITOIIET� �) AiC -A�HNOLC VNITS-�M P <br /> BATHTUB AFFRIGERATION UNITS-N P EA <br /> LAVATORY I WFSM BASINI AOILERS -fl 1 U�M P <br /> SHOWER fiASFlRED/.0 UNILS-ATU 'I <br /> NITCHEN SINK A�ISP � PORCEO AIR SVSTEMS- B T U M EA ' <br /> !`i;HW�SHEA WALLHEAfERS-ATU M <br /> ; �PUNnRV TR�V UNIT HEATERS-8 T U M <br /> / CLOTMES WASMER I L EVAPOFATIVECOOLER'. <br /> URINAL CLOTMES�RY�PS (� � � <br /> ORINNING FOUNTAIN VENTIUTION FAN � <br /> FLOOR DRAIN �ANGE HO00 <br /> BACKFLOW PREVENTERS W�TERhEATER <br /> fi00F DRnINS-RFIKLEADERS WO00 STOVE <br /> SINKISEAVICE -BAR.ETCI METALf C19MNEY <br /> FIREPIACE�NSERT <br /> HEATPUMP <br /> GAS�'ll'IN(i <br /> EMMr1U5T FAN <br /> SUO TOTAL i I �- O SU!fOTAL 1 r � <br /> PERMIT f V[RMIT <br /> TOTAL FEE ! nU iOT�L FEE �� / C <br /> ���uN�5��A�� � � ��!vu tii�rB�GK Si0[tiF fO�C� i+1.nN�;MEf,F NUMBER FEE REGEIPT N�i I <br /> ��, ,�. � _ E= ' -- g 5 19 3� ! �a�i � _ i <br /> "'`t •"'�-+ �'°"�• �.,'.rn snt FEES VALUATION FEE <br /> � ' / i�� . .l�J ::rEs ::po , ' <br /> OUILDING 5��,� ���� � � [}(� <br /> r ��� CON51 OCNPINLYGFOUC NOO�OWfI.IINUUNi�S - <br /> V�N � ' � I PWMBiNG < < Q <br /> � ��� e�,nu � r�n or voni[s M•. ucc inen <br /> ; (�z �.� � MECMANIC/1L � t <br /> I+ , Q - <br /> oT��tn <br /> �i��F SPRINkLERS REOUIRED ❑YES ❑ NO STA7E BUIL[7iNG SUNCHARGF. J �� i <br /> STATEENERG�SURCMAHGE � �:�.� <br /> .\I�[�1.�=�ill•li lii Ti15l:NEGMEOBY PI'II� I��.Ili4:�ll�lli.1 (1r � I <br /> � PUBUG WORKS :- V V � i <br /> SI� TOTAL '! ��I S I <br /> PROPFRTYOWNERSAR[ FESPONSIBLEFORDETERMIW�GALL <br /> PROPFFTY I.ME IOCATIUY.S AND REIATE�EASEMENTS. <br />