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fM ELtiFpmR ,:PPLICATION FO(..: !V[FER <br />a,YGF CONSTRUCTION <br />everP`� PERMIT <br />BUT' ;.ING DEPARTMENT <br />_09-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION Cl BUILDING ❑ MECHANICAL ❑ PLUMBING [/SIGN <br />OWNER HAIL ADDRESS CITY ?IF PHONE <br />OASCAnE SAY/ JET$ o2eab rr 3S'2r -sue o0 <br />ARCHITECT OR OE SIGNER MAIL ADDRESS CITY :r' PNONE <br />MAIL ADDRESS <br />MAIL ADDRESS <br />CENSE A <br />3r^ M4se <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY SIP PHONE LICENSE A <br />CL Sor WORK <br />NFW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />DESCRIBE WORK <br />Z'a/ST^LL .2 5E 5 /rITIVIAuna L r_TTr_zs �11LLJnAI"P'_-3EZ'�t. Wr IlL. <br />USEOFSUILDING <br />%ANfLl.lc)�L LTA- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEIT THIS AP- <br />PLICATI O N A ND KNOW TH E SAM E TO BE TRU C AND CORRECT. ALL <br />PROVISION S OF LAWS AN D ORD I NANCE S GOVER NI NG THIS TYPE <br />OF W'OPK%'.'I LL BL COM PLETLD WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. 1 HE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIWNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT_BLOCK —or --- <br />-- <br />PROJECT ADDRESS <br />c�L3y <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOI.IIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS-H. P. EA <br />- <br />BATHTUB <br />_ <br />_ <br />REFRIGERATION UNITS -IL P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H, P, EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA. <br />_ <br />KITCHEN SINK A DI_SP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />_ <br />I EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CL OTHES DRYERS <br />UPINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />_ <br />PANTIE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL F'IREPLA6E A CHIMNEY <br />SINKISERVICE-BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUBTOTAL <br />SUB TOTAL t <br />PERMIT t <br />PERMIT t <br />TOTALFEE t <br />TOTAL FEE IT <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SIDE SETBACK <br />VACANT SITE <br />TYPE Or CONS). OCCUPPNCI GROUP I NO DYES <br />DWELLING UNITS <br />MAX OCC, LOAD <br />APPOCATIONACC BY IPLANS CHECKED <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE I RECEIPT NO. <br />FEES VALUATION FEE <br />S <br />