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APPLICATIO.J FOR CONSTRUCT.JN PERMIT <br />rYPIN „ TO BE COMPLETED IN INK -PLEASE PRINT <br />theCITY OF <br />eve rett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING ✓MECHANICAL PLUMBING SIGN <br />DWNER MAILADDRESS CITY ZIP PHONE <br />TENANT � MAR A RESS CITY LIP PHONE <br />ARCHITECT OR DESIGNE R MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />MECHANICAL CONTRACTOR MAIL ADDRESS _•�� CITY ZIP PHONE LICENSE I /V <br />!7.�i �>A a.G�Si�= &Odor .�(�b,d�,CtE✓�/ 980a9 t��5-2571J 7XCSTG �`35�.e8 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />LASS OF WORN <br />i... . .. AtlnM prpAlp nFmrn ITInN WOODSTOVEiFRPL INSERT BUILDING RELOCATION <br />CONTRA„ I PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WCRK ANO SWAREFTAGE_jNV VEq/e,,o, <br />PHOPOS DUSE OF BUILDING_--�-_T <br />' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT N IS MA ND I PLV WITH THE STATE <br />CONTR ORS LAW 16. 96200 AC. <br />SIGNA OF CONTRACtOR HO D' Nf DATE <br />X 7.�I�- <br />LEGAL DESCRIPTION OF PRorERTVISNL.wN eELowoR ATTACH FouR coPlEsl <br />',OT BLOCK _ OF <br />_ <br />_ADDRESS <br />PROJECT C Z S. <br />L <br />rj— <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBIN L <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AJC—A/HNDLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK d DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />/ <br />GAS PIPING <br />.li n in <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />— <br />_ _ <br />_Lµ-Ll._-.CA.a <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />/ <br />PERMIT $ <br />C <br />TOTAL FEE $ <br />TOTALFEE $ <br />rvn vrrTVA. ...,� <br />FRONT SETBACK <br />.. <br />REAR SETBI <br />USE ZW E <br />LOT AREA <br />TYPED, CONIS ALLOWAEIf <br />TYPE OF CONS <br />SIZE OF BLDG <br />NO OF STOI <br />OCCUPANCY LOAD FIRE SPANK <br />REASON FOR SPRINKLERS <br />INTAKE BIf AAMM <br />rV, <br />PLANS APPF <br />