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APPLICATIO . FOR CONSTRUCT )N PERMIT � <br /> TO BE COMPLETED IN DLACK INK—PLEASE PRINT e rr <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS I]ELECTRIC I]___-- - — I <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION I I BUILDING fQMECHANICAL fJ PLUMBING I I SIGN <br /> OYMEfl IAA0.�OOBE55 GIiY LII' 1'lIONC <br /> �'i�/G �o �✓�'1E'G� �/� �]�2U3 <br /> I[N/Jlf W10.hU0Bl55 GtlY IIP PIIONE <br /> A11LNI7ECTOf10B/51f�iNEN N/��M1ADDIIC55 CIIV (IP � �,� `'p��(yl� <br /> �t1Ci(i Gr K lEfiGv JUFRJ�'i �'.Y�.f�/_� `��V5 f. �C�✓v`�71L._�' / -Jc�OSs <br /> cen�nn�cowumcta� ,.unnnnm�u: cnv im I'IN)NI: :;I�ILI.IGI.NSC� <br /> ���G✓ Co. PU. /�jox ?3S7 E✓�'2E'�� 1.�9 `1c�2 :3 <br /> ucu�wiuu.ca+tnncTon unnnooncss arv tn� ri�i. in¢uc[Nu. <br /> �('r'er.a�v fnA�EY' �os/�nts�zG,oN 7/02 fc�°"/gne�.n/.f QFn_-�a���./.l`I `d(�i'IS'1 ti6�AVi- �� �.t_.�E'r�3G <br /> viuuouacarrivaa� unnnooncss arv tm r�roN� srntciccrisc. F <br /> ca+rrucr vn�oc wonK <br /> OESCNIOE WdIX NID SOUNII:f W I�GE INVOLVCO fAN1�GI I•LII:�UN M111I'IKklL NO <br /> �2E�[aCi9G6 . /•X.•VJ N�/�.I' FYM /`'7�n��l[rJ-1'�`y <br /> l,�UiC/7INC r.Y�7i�'iC�1?�(l�/,�^ C2U0 ) C�(`�/ - GIO I <br /> - F 2 2 G i HEREDY C[RTIFY THAT 1 HAVE READ AND EXAMINED TH�S <br /> rnorosEouseocounowc APPIICATION AND KNOW THE SAME TO BE TqUE AND CORR[CT.ALL <br /> S�FF/f"r= PROVISIONS OF LAWS AND ORDINANCES GOVEANING THIS TYP[OF <br /> lEOALDE5Lf11P�10NOF1'NOPfP1Y�u110HT1UGlOWO(IA�lAGH1WOGpi'ICG� WORK WILL OE COMPLETEO WITH WHETNER SP[CIFIED HEFCIN OR <br /> NOT. TH[ GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[ <br /> ioi o�ocu � AUTHORITY TO VIOIATE Ofl CANCEL THE PqOVISIONS OF ANY <br /> �pF_ %NG� /JU/L./)//�/r' f/U - C43 OTHER STAT[OR LOCAL LAW REGULATING CONSTHUCTION OR TH6 <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AU7ti0HIZCD OY THC- <br /> OWNER OF THIS PROPERTY TO 'C-RFORM THE WORH FOH WHICH <br /> APPLICATION IS MADE AND I COMPLV WITfi TI1E STAT[ <br /> vu��inxi.o.eUuoeA CONTfiACTORSLAW-I 27RCWAND 200WAC. <br /> s <br /> CpNSi11UGTqNIOANLENDE11,A0011[SS,IEL[PIIONENUMU[fl ��, -� �� <br /> Q5�/z ��J <br /> PROJECTAUDRESS �U/C��h/G �O ' l,`�-3 �urc 2 .5.:i. —iun .. <br /> arvixr zsir.rr�v�x� <br /> PLUTABING MECHANICAL <br /> N0. TYPE OF FUtTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNULG UNITS—H.P. <br /> BATHTUB ' FORCGDAINSYSTCMS—O.LU. M E.A. �_ <br /> LAVATOqY(WASN UASIN) �— UNIT HCAi[HS—U.T.U. M <br /> SHOWEH � ClOTH6SDRYERS <br /> � KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD —�— <br /> LAUNDRYTRAY ' WATER H[ATEfi <br /> CLOTHES WASHER �— WOOD STOV[ <br /> URINAL ; M[TAL FIR[PLACE(WOOD OURNING) —�— <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR ORAIN �— HEAT PUMP �- <br /> BACNFLOW PREVENTERS GAS PIPING <br /> ROOF ORAINS—RAINLEADERS �— CXHAUSi FAN —� <br /> �— <br /> SINK(SEHVICE—BAR.ETC.) ; <br /> � <br />' —�— <br />�� SUO TOTAL S ; SUO TOTAL S ; <br />! PERMIT E � PEFMIT E � <br /> TOTALFEE S ' TOTALFEE S ; <br /> FOR OFFICE USE ONLY: <br /> FBONTbEID�Gf BEAtlSEiMLK 51085[lOAGN PLANGIE�M�[I F6C �� � PCGGIPINO. <br /> us[ew+e �otenee VAGANTGIIE FEES VALUATION E <br /> ❑ YES CI NO OUILDING <br />' IYr[01LONS�. �.�SI�111[.�i IICfJo'I.KV MIIYIMIII�I�tlb � <br /> ��pitl� PLUMUING <br /> 612EOFOl06. FlIICGI'IiWNLCI1511LQU U�!:GMCNI MGGIIANICAI. <br /> I.I YCS I�1 NO — '--- <br /> OCGUPNJGYLO�O FIIIl14AlIM11COU IIGIG�IfLIMII�TION �D01110NALPLANCHBGK � <br /> OTHEFI � �Z�v <br /> f1E�SON i <br /> STATG UUIL NG SUNCHAIIGC i <br /> IN7A1lC0Y iwnr+snrriwv�our CITYOFEVERER ruuucwonks '— <br /> LOCAL SALES --� <br /> D�IE TAX CODE IS 3105 rorn� � � <br />- <br />