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.x%PPLICATION FOk <br />fhe EYIrDns^ <br />CITv or CONSTRUCTION <br />aT <br />e`Jerett PERMIT <br />BUILDING DEPP.RTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION >146ILDIING ❑ MECHANICAL <br />PLUMBING <br />❑ NEW ❑ ADDITION <br />JI u.unn nr WORK ICMT OI 11 <br />MAII <br />0 PLUMBING ❑ SIGN <br />rtom <br />TERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAIION <br />-44 <br />usr OF eml rG� <br />IC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAM BE TRUE AND CORRECT. ALL <br />PROVISIONSOP LAWSANDO IN NCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLET W HWHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTIN F A ERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO ATE CANCEL THE PROVISIONS OF <br />ANY OTHER STATED L _ AW EGULATING CONSTRUCTION <br />OR THE PERFO OF O TRUCTION. <br />SIGNATURE OF II T' I RA ORIZEU AGENT oAIr <br />All IGNI'!1 IY ND.dlll SI .1 NS NO <br />L[ mll ALoEscPLOo PRoPERTY15Now ID[ )w,FIAnnal rouna rRa. <br />LOI_BLOCI 01` <br />-T �i- <br />IDII IL)Q/l r� 1 1 <br />PROJECT ADDRESS <br />PLUMBING <br />MEC NICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILETI <br />A/C - AMNOLG UNITS <br />BATHTUB <br />REFRIGERATION UNITS -H P. EA. <br />LAVATORY ( WASH BASINI <br />BOILERS - B.T U /H P <br />SHOWER <br />GAS FIRED A C. UNITS - B T.U. <br />- <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS - 9.T.V. M EA <br />DISHWASHER <br />WALLHEATES-B.T.U. M <br />LAUNORY TRAY <br />UNIT HEATERS - 6 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />_ <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />TOTALFEE <br />I•L/A r+C11ECK NIIMRGR 0IF.E <br />ffff.••• <br />(�I <br />RECEIPT NO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE! <br />I <br />+ / <br />LOT AREA <br />VACANT 8IL <br />OYES10 <br />/ FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONS <br />OCCUPANCYGTIOUP <br />B -Z <br />NO OF DWELLING UNITS <br />`e:;,- <br />PLUMBING <br />SIZE Or BI DO <br />��yV CF �� <br />NO. OF STORIES <br />H A��; r•� t <br />4 l <br />MAX. OCC /�LOAD <br />MECHANICAL <br />C <br />OTHER <br />_ <br />FIRE SPRINKLERS REQUIRED O YES ONO <br />STATE BUILDING SURCHARGE <br />APM ICARON ACC O+ PL%NSCHECKED BY <br />/% <br />APRA FOR ISSUANCE BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />YHVYCHIT VYincna nnc nc�rv.+••+.�•�•••-� �••-•�� <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />