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APPLICATIC"`1 FOR CONSTRUCT`lN PERMIT � <br /> TO BE COMFLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT L HEATWG SYSTEM: GAS !J ELECTRIC J___--� <br /> 259-8810 <br /> DEMOUTION COMBINATION �BUILDING XMECHANICAL PLUMBING I i SI(iN <br /> OYMER M 1R00RE55 LRY 21P PHONE <br /> �L �OIYI ��.(Z. ?:�� �'' ��C� 1/.S ��3Z�L.=�:�'c'c12) <br /> TENRN' MAiL AppRE55 GrtY b� Fr�ONF <br /> ti3NE <br /> Af1CNiTECTOR0E5iGNER MbLA0�RF55 CITY ZiP PNONE <br /> J`f�C17C�'l�1 ' ,' fcJ Tcyl' �70b LK OScC�-co, �� `�J034 <br /> GENERRl60NTR�(,iOR M�Ilp00RE55 GITY � ZIP PMONE SiREUCENSE• <br /> ,�Q��'p�, t-�OMf--`��-�-r�C � 1344 �G/fLVN/.5��/ l�t�%/ =�-Zt� �ONSN/(I'a8%L7- <br /> MECM�NICAlGM11R�LTOH MAILIIDURE55 CITY .'iP PNONE STATELICENSE� <br /> ��.DEf�uJObD St{T� M£7�4L (o7lJ -l�S� <br /> PIUMPING�iR�CTOR �IL�OORE55 GTV 21P PNONE ST�iE IICENSE I <br /> �,lfw c� � ��� �✓M r3 . _ ` ---- 337- 605'�, <br /> CONiR�CT PRICE Of WONN - �, ' �� ' <br /> OESCRIBE WOPR�ND SOV�NE FOOTACF�OIV D .:ON1AG E iON�ii�)P�,NE NO �yA^��^ <br /> iirz.�,.7 --r� �.,�.��� <br /> 1 ��'�Hr' /��A�'N�r 2�� ��� <br /> C,A2 . �r46��. u� �r _�IZ W J i� 9zo <br /> i HEREBV CERTIFV THAT I HAVE �iEAD AND EXAMINED THIS <br /> VROVOSEDIISE OF BUILOIN� � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��i�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �eoe�o�qNOFPROPERTYI5110WNBELOVIOR�TTACHiWOCOPIFS� WORK WILL BE CCMPLETED WITH WHETHER SP'CIFIED HEREIN OR <br /> V2� ' p NOT. TNE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> ior n�ocK - AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV I <br /> (wf�y OTHES STAT OR LOCAL LAW EGULATING CONSTRUCTION OR THE , <br /> r� ��� 7 ERFORMA E OF CONSTR ION.THAT I AM AUTNOHIZED BV THE I <br /> Q��- �OfJ S � p NER OF HIS PROPERTV 0 PERFORM THE WORK FOR WHICH ' <br /> __�=���__. �— PPLICAT� N IS MADE ND 1 COMPLY WIiH THE STATE <br /> P�Rf,EL T�%I D NUMBER CONTRA RS LA tB.27 W AND 296.200 WAC. <br /> �� - oot� -- css -oa�/ l <br /> CONSTRUGTIONLOANLENDER �DG�ESS.iEIEPHMIENUMOER � / <br /> WOD/��UQ7t,�CE r a <br /> PR ECT ADDRES I(�, src:H une o�c <br /> 7 1 �VJ � CIIYflU$H1t5511(f4C(µ <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FUITURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE .-;-:;� '` <br /> WATER CLOSET(TOILET) � NC--NHNDLG UNIiS—H.P. �_ � <br /> 2 I IM <br /> BATH7UB / ; FORCED AIR SVSTEMS—B.LU. M E.A.// . � ''k <br /> i_ c.�� <br /> LAVATORV(WASH BASIN) / � UNIT HEATERS—B T.U. M T_ � ,:;;j1 <br /> SHOWER CLOTHES DRYEAS / ' , . <br /> KITCHEN SINK d DISP // VENTILATION FAN � � ���'�eY� <br /> DISHWASHER �/ Z RANGEHOOD ' � . "y�� <br /> IAUN�RV TRAV ; WATER HEATER � �- <br /> CLOTNES WASHER WOOD STOVE ".>�., � <br /> URINAI METAL fIREPLACE(WOOD BURNIN ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT �f�S <br /> FLOOFi DRAIN HEAT PUMP '_ <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> HOOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR.ETf,.) I <br /> _ ; <br /> �2E sPa�NK � ao � Jv <br /> , <br /> � <br /> �T <br /> I <br /> 1 <br /> SUB TOTAL $ SU0 TOTAL S d O 'dt) <br /> PEHMIT $ PERMIT S ��� <br /> � TOTALFEE $ TOTALFEE S - J 'J�� <br /> FOR OFFICE USE ONLY: vs �3(c �.j <br /> FRONT SETB�CM LE�R SE78AGN SIDF�r��CN �IAN CN,E�NIJM�E FfE NECEIPi N;� �� <br /> �� � � // y/ <br /> � `r `- <br /> use zoNe lOT ARF.� VR(:�NT SITE FEES VALUATION FEET_ <br /> �2 ��7�� �'rYES .� � NO 2��ISZ �_' " ' <br /> BUILDINC J-� ��'� <br /> 1YPE Of COIiSt NO OF STORiEb acuP�xr. im n wi[wxcux��5 � � � <br /> —� 01'� Z PLUMBINf; ' <br /> SIZEOFBI FlFFSPRINNLFRSRkO� BASEMCNT MECHANICAL I��� � �l� <br /> V�G��� �C YES �. � NO q ; <br /> OCCt1PI1NCYlOAD FIFE MPE00 NEIGNTLIMITAtION ADDI?IONALPLANCHECK p � � � <br /> a < , � z� _ OTHER a� i ��-> <br /> J <br /> 1 <br /> REASON n_' � �I. �\ b/iS/ljfL SiATE6UILDINGSURCHAPGE '� C� <br /> y't i r ��7� <br /> INT�NEBY PL�NSAPPRO/EDBV CITYOFEVEREIT PUBLICWORK$ � ✓✓ <br /> LOCAL SALES ; <br /> � �,p,E TAX CODE IS 3105 TOTAL �j D <br />