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� r • <br /> APPI.ICATIQ"� FOR CONSTRUCTi'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRiNT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS ❑ELECTRIC ❑ � <br /> 259-B810 <br /> DEMOUTION � ' COMBINATION I i BUILDING �MECHANICAL ❑PLUMBING ' I SIGN <br /> OWNER^ /� / M�iL�pDFE55 GTY ZiP PM NE <br /> TEN�NT M�II �CN� �� GITY / �_ IIP PNONE � <br /> �C <br /> pRCNITEGTORpESIGNEN MMLRD)Pk55 CITV 2',P PHONE <br /> GENF. �L LONTR�CT R Il�I�OnE55 CI ' 21P PHONE STA E LICENSE� <br /> � _ „ , ��� ��R'od 7t�a��yi ��A—��l`�j �.�'��1�Hdl��o� <br /> MECH��L CONTRACTJ A�IV ODRE55 CIT" ZiP PHONE ST� E IICENSE• <br /> �`� ` <br /> PLUMBINGLONTRAC M�IL�D�R[SS CITV 21P PHONE ST�IEIICENSEt <br /> �A rnr-' <br /> CONTRRCT PRICE OF Y/ORIt <br /> DESCRIBE WORK ANO SOUARE FOOU(iE INVOIVED LONtACT PERSON AND PHONE NO • � <br /> S <br /> t��_ C�_(� �n� ('rA C�n �K �(�f <br /> __ i HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> rr�oroseo use ov euaoiNo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDESCRiP�qNOFPROPERtv�SHOWNBEIOWORATTRCNTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO GIVE <br /> iot— — e�ocK ov AUTHORITV TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />� — PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZ.ED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS 0 LY WITH THE STATE <br /> P�RCELi�%IONuuBER , CONTRACTOF 1B. 6. OWAC. <br /> CONSTRIICTION LO�N lENOER.�DDRE55.TEIEPNONE NUTABER S O �� ^ <br /> PROJECT ADDRESS sc rone wiE <br /> UlvqpSMf55l1LFN5f W <br /> PLUMBIN6 MECHANICAI <br /> NO. TVPE OF FO(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HM1DLG UNITS—H.P. <br /> BATHTUB FORCEDAIRSVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T U. M <br /> SHOWER CLOTHES DRVERS <br /> NITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV WATEP HEATE9 <br /> CLOTHES WASHER � WOOD STOVE <br /> UPINAL METAL FIFEP'_ACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE IIJSERT <br /> FLOOR DRAIN HEAT PUMP <br /> DACKFLOW PREVENTERS GAS PIPING <br /> ROOF ORAINS—RAINLEADERS EXHAUST F4N <br /> SINK(SERVICE—BAR,ETC.) <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT $ PERMIT E <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSE7BPCN REARSEIBAGR SIOESETBACN PIRNCMECkNUMBER FEE AECEIPTNO <br /> �L�r+ —� <br /> USE 20NE iot�nee wc�NT srte FEES VALUATION FEE <br /> � - VES � � NO BUILOING <br /> IYPFOfLONSf NOO�SiOR1E5 aru»ew xow�wfmrcar�•5 <br /> �P0°o pWMBING <br /> SIIEOFBLOfi iIRESPNINeLEP5RE0'D B�SEMENt MECHANICAL <br /> � � VES � � NO -- <br /> OccU'�NCVLO�D FipEMMMPEaD NEicNTliMrt�nON ADDIiIONALPIANCMECK <br /> OTHER <br /> Rf�50N <br /> S7ATE BUILDING SURCHARGE <br /> INTANE BY Pl�NS�PPROVEOBV CITY OF EVEREIT PUBLIC WORNS � <br /> LOCAL SALES <br /> onre TAX COOE IS 3105 TaTAL <br />