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�PPL.ICATION f0�.1 <br /> ""`""'� CONSTRUCTION "e <br /> un or <br /> ever�tt PERMIT <br /> BUILDING DEPARTMENT <br /> 259�8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOiiTION ❑ COMBINATION �llBUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> pµbL�1 M�II�OORE55 CIiV ZIP ,PMON[ <br /> 1'/I//-iP /14. F_;Ic-i, /S3/ Rue,�EK �IGc EdEKeTr �a�-�n/ ( /�3f�y 2y�I �'�� <br /> U1C�a1CG10�Ot5�ONEN ML'! �OORE55 CItY 21P 1MONC <br /> Jk'KcyuRA� D�s�c.N 54.3ci l9�7µsT a.w� �Yti'NI��P 9do3G 745- 7y3y <br /> GtNCN1L GONIR�GIOR M�II AOORE55 CIi� zlP PNONE UfCNSE• <br /> .nwN k,� <br /> Mff1UNiC�tCONIR�Gfpq MML��DRE55 , CI1Y ZIP PNONE �i�CNSf• <br /> /1�D/✓E <br /> i'LUMflVl.CONiRACiON AIML�DDNESS LIiY 21P PIIONE IICENSL • <br /> /Va�JE <br /> CU550�WORM <br /> � NEW ❑ ADDITION ❑ 5�.TERATION ❑ REPAIR ❑ �FMO�ITION ❑ WOODSiCVE/FRPL.INSEtiT ❑ BUILDING REL7CATION <br /> V�W���ON O�WOpK ICOBI Of AUIL�UI S PLUS I�POR� <br /> /'�5. OOcfI. `< <br /> ot5cnieEwuPn � � } / ,�y <br /> !1,0 0 c� � F, � ���i;ti,.�.ee. i ir <br /> Ptti .-d tc�at.�'o� <br /> UtiCOfBWIDING � <br /> /�L!�'� ��2� � �f, I HEREBY CERTIFY THAT I AVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNON THE SAME TO BE TRUEANDCORRECT.AlL <br /> 11.G�L0E5C1UPIlONOfPFOPERfY15NOWNBEIOWOF�iI�GNFOVRLOPIE51 pqpVI510NSOFlAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WOHK W�LL BE COMPLETED WITH WHETHEfl SPECIFIED HERE• <br /> io�—e�oc�or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITV TO VIOLATE OR CANCEL THE aROVISIONS OF <br /> �Lf l�Rr�lt//�l/6' S ANVOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCiION. <br /> SIGNATUREOFGpNiPnC10RO11AUiNOnIZE0nGE117 Dni[ <br /> X � ' �� � � .�—�3-�� <br /> 1'NOJFG��D�HE55 I � �PPLIC�NI'SGIIYBUSME. ULENSEN� <br /> ��� _JI�9II/{ SI �PE� / Wr.� e�..Q� /LK <br /> PLUMBINO MECHIINICAL <br /> NO. TVOE OF FI%TURE FEE NO. iYPE OF EOUIPMEHT FEE <br /> WATERCLOSET�TOILET� � AIPCOND.UNIi$—H.P.EA. N <br /> BA7HTU8 � REFRIGERATION UNITS—N.P.EA. <br /> �AVnIn11YIW�91111�1:RlI 11llllfll: III` f� <br /> ---i __ <br /> . ._ . ._'" _ ___"_"'_' ' ' "" _.. . <br /> __ SHUWER CAS fIR[D A.G.UNI�S—TONNAGE GA. <br /> __ NITCNEN SINK 8 DISP. FOHLED AIR S�STEMS—B.T.U. M EA. <br /> __ DISHWASMEP Wr1LL HEATERS—B.T.U. M ___ _ _ <br /> LAUNDRYTRAY UNITNEATERS—B.T.U. M __ <br /> CLOINES WASHER EVAPORAiIVEC00LER5 <br /> WATEfl NEATER CLOTHES DFVERS <br /> � URINAL VENTILATION FAN <br /> DPINKING FOUNTAIN flANGE HOOD <br /> FLOOR DRAIN AIR HANOLING UNIT— QF.M. <br /> V�CUUM BREAKERS STOVE <br /> ROOF DRAINS—RnINLEADERS METAL FIREPLACE 6 CNIMNEV <br /> $INN�SERVICE—BAR.ETC. WOODSTOVE/fIREPLACE INSERT _ <br /> SUBTOTAL SUBTOTAL f <br /> _� PERMIT 3 _ OERMIT f _ <br /> ___�___ TOTAL FEE f TOTAL FEE f __ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> 11WNISf10�CN HLARSCIO�CN SIOESELB�CN PLANGHECKNUMOER �L�NCNfCkIGE <br /> � C� O � � ree �/ q S 3 n[r,[mt No Cr/�V� <br /> UtillUNl �J LO�Al1U /� V�CANiSRE /J --- <br /> C�(i sr tQV[5 ONO FEES VALU�TION FEE <br /> �vP[Off.ONSf OC��NLY iOUP HO.OFOWELLINOUHIIS � ` ��•� f� � / <br /> �_� ��� 0 OUILOING t�'�(S�. CQ�y/ SO <br /> tiitl oi It1QUG/ / NO Of S10RIE5 M�%OL�C/1,O�0 - --- <br /> QID� Sr I �f+� PLUMBING _ <br /> MELIIRNICRL <br /> fIH[SPPINHLERS FiEOUIREO ❑Yf:S NO <br /> O11/ER <br /> ��'�'I�CAI�ONeCC Bv PLANSC��ELhEDBr APiR.iORI55UANGEBY PENALTY �`' � „���,�.� �) �� <br /> TOT11l �:��� � <br /> �,� . �M . J€� G . c . — �;:. �,, �.� — <br />