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APPLICATIQ ' FOR CONSTRUCT' �M PERMIT � <br />TO BE COMPLETED IN BIACK INK—PLEASE PRINT <br />_ — -- -- ---- _ . - -- _ <br />� HEATING SYSTEM� /J JJt <br />BUILDING DEPARTMENT i J GAS J ELECTRiC �I � _ _� <br />259-8810 <br />DEMOLITION COMBINATION } BUILDING MECHANICAL PLUMBING SIGN <br />nw��Fa r.�ai, n[�n��tss cnv :,r vHovr <br />_�'lA¢Fn� CAaack y611 BtU„ovr �qw� Ev6e� 4l��'� 3SS-(lzb' <br />��hma qa�AounEss cirv � tm vr�oqF <br />_�SAMF) <br />ni�aurecr on oesicHea �.�nn ao�a�ss crtv zir r��otie <br />J�r 6�1��1 � N�X�`rsFAoc SU�rF'�E'' RRtiNktn� y3.C-Sl9d' <br />](Nf.RAICDNiN4CiOR I.IAILADORCSS GITV li�' Pr1pNC SiATELIC[NSE• <br />I.�FOIANICALC.ONiRACiOR MRILADURESti <br />�I� <br />°ItIMBiNGCONI�RCTOR MRiLA00R[55 <br />CGNTRPCT PliiCE O WORN <br />II 26`f <br />�EscnioE woarc nyo souagE c orace <br />CRV LP <br />GITY zip <br />GONTr1Ci PE1i50N AND PMONE NO <br />PnONE <br />PMONE <br />StAiE I.iLENSE I <br />�QY s�, �• _ ME 1'�,.< � 3 s�- l/z8' <br />i HEREBV CERTIFY THAT I HAVE READ AAD E%AMINED THIS <br />v�+oroseo use ov emioiNe APPUCATION AND HNOW THE SAME TO BE TRUE AND CORRECT ALL <br />�� v rl A( PROVISIONS OF LAWS AND ORDINIINCES GOVERNING THIS TVP[ OF <br />iecnioescWianenotaaoreatvis��owNeeiowonaruo�rnocoviesi WORK WILL BE COMPLETED WITN WHETHER SPECIFlED HEREIN OF <br />ioi� e�ocK —�^-��..pF �—B£�M� CANC NOT. THE GRANTING OF A PERMI� DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHEF STAfE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />— PERFORAIANCE OF CONSTRUCTION. 7HAT I AM AU7HORIZED BV TME <br />OWNEP OF THIS PROPEFTV TO PCRFORM THE WORK FOR WHICN <br />vnace�inMioNuueen APPLICATION IS MADE AND I CUMPLV WITH THE STATE <br />CONTRAC '�AyV 18.27 FCW ANU 296 200//W�///')))���'''(((��-``` <br />CON=;RUCTIONIOANLEND[R q00RE55.iELEPNONENUMBER / /'/ / J"',� <br />,., <br />�-,-lr(� � <br />PqOJ T ADDRESS � ���� i����in o��� <br />f.nrBuSAfSSu�lpy r. <br />PWMBING MECMANICAL <br />NO. TVPE OF FIXTURE <br />WATER CLOSET �TOILET� <br />BATHTUB <br />AVATORV�WASH BASIN) <br />S WER <br />KITC N SINK 8 DISP <br />DISHWA ER <br />LAUNDRV AV <br />CLCTHES WA ER <br />FLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAINS <br />SINK ISERVICE <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FNOHtSfIpACK RFRR SEiB�LN <br />� ' / _ <br />us[ toNe / �otnnea <br />�� / <br />��i'I i11 COHSt NO OF SiORIES <br />_� -J� <br />y4F OV BIDG FIRE SPHINNLERS RFOP <br />�� S u � — <br />OLt:ilPnqGv10�0 FlREMRPMPE00 <br />nl �D. I�10 <br />RI N�ON <br />rt�lnrl !rv �iANS���'NI,t�FUPv <br />J� <br />onrc �. /1 /�s..r <br />A�C—A'HNDLG UNITS—HP <br />' 'ORCED AIR SYSTEMS—B.T.U. M E.A. <br />U THEAiERS—B.TU. M <br />CLO ES DFVERS <br />� VENTIL ION FAN <br />PANGF H D <br />I WATER HEA . <br />FIREPLACE INSEFT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />S�DESEiP�C� PLANG�ECM110A1BER <br />S y _3- <br />vncnnr sire FEES <br />VES NO BUIL�ING <br />m,. :xi�....�.. --__—_ — _ _ <br />_ PWMBING <br />_—_�— <br />BRSEMFNr � � MECHANICAL <br />VES YNO -- <br />HEIGHi uMltAiION ADDITIONAL PIAN CHECK <br />Z ' <br />_ OTHER <br />STA1F BUILDING SURCHARGE <br />CITY OF EVERCTT wuoi ic worvKs <br />LOCALSALES <br />rax cooe is 3ios TOTA� <br />BURNING) <br />SUBTOTAL $ <br />PERMI7 $ <br />TOTAL FEE $ <br />FEE <br />T' <br />u� � <br />