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APPLICATIQ"�! FOR CONSTRUCT'-1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: U GAS U ELECTRIC O <br /> BUILDING DEPAATMEP�T <br /> 259•8810 <br /> L] DEMOUTION �4 COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING LI SIGN <br /> OWNEP M�IL���RE55 CITY ZIP ��� � �� <br /> 4�� ,�ts,�'•ar.��..�I 306 CEA�ST �{Plt7j'_� P�E � <br /> ARCHREC�ORDESIONER M�RADDRE55 LIiY ZIP VHONE <br /> O��L CONTFIICTOR M�IL�DDRE55 GI1Y DP PHONE STAiE LIGENSE/ <br /> MECNANIGQ CONTR�GTOR MAII�DORESS CI1V IIP PMONE ST�TE LICENSE� <br /> PLUMBIN�CONTR�CTON MMIMORESS dTV ZIP PNONE ST�TELICENSEI <br /> CONiR�GT PRICE O/F�(y/,pqK �� �/`J� <br /> � ESCPIBE y/q�M�qp ��T�OE INVOlVEO V C> TACT PER �NO PHON 0 <br /> I ,� � � <br /> i HEREBV CEPTIFY THAT I HAVE READ AND EXAMINED THIS <br /> v�ED USE OF Bl11LD11 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PflOVISIONS OF LAWS AND ORDINANCES 60VERNING THIS TYPE OF <br /> �Ep�� � IpTYN10FPROPERTV15110'NNBEIOW—ON•.A.TT�Cr+iwocties� NOT THELGRA TIONG OF AD ERMITyDO SENOT R'ESUME TO 61OVE <br /> �oT eiocK � �`���" - AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Ew�ar �/� OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> �V�� PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEb BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAUE AND I COMPLV WITH THE STATE <br /> P�RCEL i�%10 NUMB R� CONTRACTORS LAW 1827 HCW AND 2962 AC. <br /> CONSTRUCiION LOAN LENUER,/�DDRE4S TELEPNONE N1IMBER _ ` 1 <br /> d J <br /> P AD awruuE wtE <br /> PLUMlINO MECMANICAL <br /> Np, TYpE Of flIITURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC-A/HNDLG UNITS-H.P. � <br /> BATHTUB FORCEDAIRSVSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M � <br /> � CLOTHESORVERS ' <br /> SHOWER -- � <br /> KITCHEN SINK 6 DISP ; VEPITILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> UUNDRY TFAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ' <br /> URINAL METAL FIREPLACE(WOOD BURNINQ) ' <br /> DRINKING FOUNTAIN � FIFEPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP �_ <br /> BACHFLOW PHEVENTERS ; GAS PIPING � <br /> ROOF ORAINS-RAINLEADERS � EXHAUST FAN ' — <br /> I SINK(SERVICE-BAR,ETC.) � � <br /> � � <br /> � <br /> � <br /> ''y� � --� <br /> 7 , ' <br /> ��:t.1� SUB TOTAL E � SUB TOTAL { ' <br /> 1 <br /> PERMIT S PERMIT S � <br /> — TOTAL FEE S U ' ' TOTAI FEE E / <br /> ,, � ✓ <br /> ''` FOR OFFICE USE ONLY: <br /> �.�:� FRONTSETB�CK RE�RBE(BI1CN SIOE6ETB� N PUNCN NNUMBEN FEE REG� J� /� <br /> �,: <br /> 1 � S Da a-' / �"Jd� <br /> �+'�� VALUIITION FEE <br /> "�`,� USE IONE� l0T�RE� VAC�NT SITE �ES .�{ <br /> '���. VES �I NO BUILDING � � �v O <br /> �.- STORIES ncniP+wcv rroawrtwx.uwi�s � <br /> � TYPFMCONSL � � � <br /> ,.: N "�'.'3 PLUMBINO ' <br /> ,�� 52E� FIRESPRI LEPSREdD B�SE�NT MECHANICAL r � I <br /> Sb4 5F• I71YkI J f�?'YES �..� NO � <br /> '+` �� FiqE�URMAEoo HEI(3NTlIMIr�tioN ADDITIONALPUNCHECN <br /> OCGUPANCVl0�0 ' � <br /> 1� <br />, N q u orHea � <br /> � <br /> RE�� STATE BUILOINO SURCHRROE <br /> INUNE BY PUN$�P RQVED BY CIT1�OF EVEREIT PUBLIC WORKS � <br /> u LOCAL SALES 3/ ; G <br /> o�Te S�s��j3 TAX CODE IS 3105 Tor�� � <br />