Laserfiche WebLink
IMEvnpn�n <br />Clll oF <br />ever�tt <br />BU!LDING DEPARTMENT <br />259-8810 <br />aPPLICATION FOh ' <br />CONSTRUCTION <br />PER11�lI�' <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />� i <br />� ���,�� <br />e� <br />I <br />C DEMOLITIO� ❑ COMBINATION I�BUILDING ❑ MECHANICAL Cl PLUMBING ❑ SIGN <br />owr�ee � :a�u. nnoncss cirv 21P P�ION[ <br />S+� ��J ��o � rn o r�c ���»- S�. �., a c u �! V`��\\ \i�� ���\`b'�.��5 �.,���5c� -\`a � a. <br />nRC11RECiOROISIGNEB MMI MOfIfSS <br />\JW �� — <br />GENEFAI.CONTRACTOR MPIL a��flLSS f.i�Y [il' P��ON[ �.IL[NSE • <br />W `(� 0._.C� <br />MECHANIGL CONTRACTOq Mnll. ROORE55 CIIY LIP PIIONL LICLNSE • <br />PLU INGCONTRiOR MRILAODR[SS CrtY Z�P PIION[ UCLIlSE� <br />•��� c <br />GLA550: VIORN <br />❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ SNOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAWnTIONOFWORM�COSTOFMATERInLSPWSIAB�R� ' u <br />tl _ <br />USE OF B W LOING <br />Lpi_.BlOG1�— <br />PLUMBING <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORVIWASH BA: <br />SHOWER <br />NITCHEN SINK d OISP. <br />OISMWASHEH <br />LAUNORVTRAV <br />CLOTHES WP.SHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOH OPAIN <br />° DRAINS — I <br />ISERVICE — <br />I fiEREBY CERTIFY THAT I HAVE READ AND EXAMINED ThiIS AP• <br />PLICATIQN ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSGF LAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERM�T DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL :AW AEGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONS7RUCTION. <br />SIGNAIURE OF CONIRnCTGR OR Al1TMORIZE� AGENT [tATE <br />X ,2 . <br />-13- <br />APP�ICANTS f.liY OOSINE55 LIf.LNS[ 110 <br />MECHANICAL <br />fURE OR ITEM FEE NO. TYPE OF EOUIPMEn7 <br />�' A/C — AiHNOLG UNITS — H P. <br />REfRIGERATION UNITS — HP EA. <br />N� BDILEPS — B.T.U/N P. <br />GAS FIRED A�C. UNITS — B.T.U. <br />FORCED AIR SYSTEMS — B?.U. M EA. <br />WALLNEATERS—O.T.U. M <br />IJNITHEATERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />— CLOTMESORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />�5 WATER HEATER <br />EADERS WOODSTOVE <br />�C � 61ETAL FIflEPLACE d CNIMNEY <br />a� �U FIREPLACEINSEPT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />%PONTSETB�CN AEPR SETB�CH <br />USE20NE LOTAFEP <br />NPEOFLONST OCCl1PnNf.YGROUP <br />;iZE OF BIOG NO OP STORIES <br />FIRE SPRINKLERS REOUIRtD C YEi ❑ <br />4VCIICAtIONACf. QY PLMNSCNECNEOBY <br />SUBTOTAL <br />PERMIT <br />VLAN I:MECN NUMBER I FEE I AECEIPT NO. <br />V�LhNT51IL <br />❑YES IJNO <br />- " DING <br />MA% OCC <br />8Y <br />PLUMBING <br />5 <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE ` <br />STATEENERGYSURCHARGE <br />PU6LIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATEG EASEMENTS. <br />