HomeMy WebLinkAboutBLDG-19-000295 s_ . ea 7.
'ICaTYI Mr4o %\- I la DAZE` 7-9-/I VI :G -r`-090:9
r
ADDREssLa 9' U I rt t L A. s-{- INNERS NNE LbN ' t'eII.1._ }
G OiIMERADORESS ti jaV/37367- 1"344....A
1
raiz OR OCCUPANCY TYPE BALD EDUCATIONAL 0 •,o: i : El
PUNT
CLEARLY tett RE?IOVATIOIt❑ REPLACEMEM:O PLANS " 4 = t YES[] NOD
APPLIANCES'I MOORS-. t 1 BSM 1 1 2 1 3 4 5 6 7 6 J 9 ISM 14
BOILER
BOOSTER
III
CONVERSION BUM 3t I Illiir
COOK STOVE
DUCT VENT HEATER
FI 11.ni.nn a ,
FRYOLATOR
RJRNACE II all',r 1I
GENERATOR a 11111 NM MN MN MN NIII
MAE 111111 MN 11111111111111 EN NMI MN
INIRARED HEATER -NNIIINII - ■N 1•
LMORATGRYOOCKS
AWIKEUP AIR UNIT MI 1111111111111 S an an
OVER • 1.—MINS NM SII IIIII 111111 Ng
POOL HEATER IS rs I♦ 11111 INN -
ROOM,SPACE
UNIT HEATER USN. III ■ 1/
ROOF TOP UNIT
! FMIeTER
ST
7 111111111 laTER
DIN:T-
Y I Iia 11111 1
INSURANCE COVERAGE i!_
i ham a cwnnt�th.wancs policy or Its aub im&I agldr*ndnpbh mob Um midmostlbof MGI.Ch.i}2 YES Q'NO 0
IIFYWQIBCI Dfl$JIEASESWAT!THE TYPE Of •• : . • BYCHECI TIEAPPBOPRIATEBOX BELOW ' 1 /
LIMO I4SURANCE POLICY ►i OTHERTYPE INDEMNITY 0 BOND 0
OWNERS WSUiACEWAIVER:Ia nothtlta Kann SftistiblyaVosinsiconto towage nq*s4YyCat! .. 142d Me
tbranaMnKS Gard Lan and the my Mp%*un on this pane appNatlonKahn this nqu amaat /,
OW ONE ONLY: g. 1 t 0 AGENT 0
MGNATUREOFONII,:- AGENT
Italy cot Oat asdasiSias and Salim Itara oulanibdvenured wpa.1n0Nsapa6ottlanarebus and sail, . Irma dory d
IMantlk+ r
and MSS plumblgw#adkutallikespa bmedundrprink rinkiawdbrOssppaaiaond - ,.be • with NI ;
amuts 14P%mdngCoosadChoi*142aiheGuwalLewa ,9 eA ,J
PLUABER-0ASRTT6+.NAME K9 ,4 Jrz
e ,J ILfCDISE•MI / .A IURE
w o AG0 j'0 n(gl LPGID CORPORATION Di ( 04 ; ]MO DC
rKer Rd J
couPANYNAUI�[Ere j9' ���r�a� IAf�Ess� yU/ � _____�
'an 2r+- b4(r 14bl-e ism mn- re o. ea = 77V' - 7- a
FAX __'I C y,��ga- erfo-J vat e spew.. t j
7v' *7-
1•2<frfr 74 -
a 91d -mo0 s � "t/3/1()/