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APPLICATIC�1 FOR CONSTRUCT 1N PERMIT � <br /> \ TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ��P - <br /> BUILDING DEPARTMENT HEATING SYSTEM•. f,J G S ELECTRIC U _� � <br /> 259-8810 ' <br /> f I DEAGOLITION I I COMBINATION ,r`G BUILDING ! ' MECHANICAL i ;PLUMBING � i SIGN <br /> OWNER Oi.���L' M�ILADDRE55 CI7V ZIP PNONE <br /> �Xf �'�I �Tr}w-BS �Q, 3fY2G �E.f�6sd �'Ctur, /5�.�,�- (oY'°� !/�'/f/F QA�'b�'a /.�/,Q Sda// '. <br /> TE11�NT AUIL�DORESS f.IIY ZIP PHONE <br /> - yA6� 9� 33 ' <br /> �RCNITEGTOROESIONER MAIL�DONE55 CRV 210 ��MONE - <br /> S�4 N.�E <br /> OENEP�LCONTR�CTOF MRILAD�RE55 CIiV IIP PHbNE ST�TELICENSE/ <br /> Srr N-t R <br /> MECN�NIC4LGONTP�CTOR M�II �DDRESS GTv zlP PNONE ST�iE UCENSE• <br /> PIUMBINGCIMl7/qACiGR M�iI�DURCSS CRV ZIP PHONE S7�TELICENSE� <br /> � � �`, <br /> CONiRACT PRICS OF WOPIt <br /> �G O,DO� 00 <br /> DESCRIBE WOPK�NL SOU�RE FOOUGE INVOlVEO COniRGi PERSON AND PNONE NO <br /> Ni�f�l fc°�.S'. /�B� /.� . A/J� <br /> � <br /> �D � �sd � , / <br /> I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDIIIb APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �ESYO6NC-�E. PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEOAlDESCRIPTIONOFPROPERT�'�540WNBELOWORATT�CHTWOCOPIE51 WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or� e�ocK -- o���YS 1900?fQ4f NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> AUTHORITY TU VIOLATE OR CANCEL THE PFOVISIOhS OF ANV <br /> OTHER STATE OR IOCAL LAW REGULATiNG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> nl��r� O� 2 OWNER OF THIS PROPERT'( TO PERFORM THE WORK FOR WHICH <br /> PARCELT�%IONUMBEH APPLICATION IS MADE �ND I COMPLY WITH THE STATE <br /> �iX�� �OO���^ CONTRACTORS LAN '827 RC1V AND 296.200 WAC. <br /> CONSTRUCTIONLO�NlENOER. ODPESS.TEIEPHONENU FR <br /> �YAS�I. f�D. s<<, -f/h� _ �/ r!o '�,/4-�i3 <br /> PNOJECT A DHESS s r�t �+*E <br /> 0508 c+40 Y r<o.a� �, A��.mE=S,�F�sE� <br /> PLUMBINO ECHANICAL <br /> N0. TYPE OF FIXTUHE OR REM FEE N0. TVPE OF EOUIPMENT FEE <br /> . WATER CLOSET(TOILET) /vC—NHNDLG UNITS—H.P. <br /> ——:-- <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> ,3 LAVATORV(WASHBASIN) UNITHEA�ERS—B.T.U. M ; <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINH 8 DISP VENtILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL ' METAI FIREPLACE(WOOD BURNING) �i ��� <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FIOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> � — <br /> � <br /> SUB TOTAL $ SUA TOTAL E '� <br /> PERMIT S PERMIT S � <br /> TOTAL FEE $ TOTAI F[E S <br /> FOR OFFICE USE ONLY: /C� ,�2_ �`- 2,�JZC/1!'(L�[ <br /> FRONiSETBACK PEAPSETB�CN SIDESE�B�CN� PL�NGHECNNIIMdER FEE PECEIViNO <br /> � - � 5 �3s� 3��.��.� a�s� <br /> USE ZONE iot�Aen V�C�NT SI7E FEES VALUATION y FEE <br />� �� '�1 VES .-. NO BUILDING � �j3Z 7 .C�79 ' <br /> 1YMOiCONS1 �OFSTORIES otmv�s,-r rpp�pxnuNcux��n --- <br /> 2 " PIUMBING 7 7� <br /> SI�F�FyXiSf� FIRESPRMKLERSPEbO BASEMENT MECHANICAL — 90 � <br /> < < G� V �l VES NO , <br /> OCCOPNICYL,�D FIREAUPMPEOD HEIOHTIIMITRTIQl! ADDITIONALPUNCHECK - � _ <br /> �tl� D� � ' -�„�- <br /> RE�SOH <br /> STATE BUIL�INO SURCHARGE <br /> INTANEBY PLANS�F ROyEOBY CITY OF EVEREIT PUBLIC WORKS � � <br /> IV LOCAL SALES <br /> DATE � ya 93 TAX CODE IS 3105 rorn� ' ��� <br />