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APPLICATI�,�1 FOR CONSTRUCT�ON PERMIT � <br /> TO 8E..JMPLETED IN BLACK INK—PLEASE PR�nT <br /> ,5 <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS 0 ELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOLITION L"1 COMBINATION 1=.1 BUILDING �MECHANICAL CI PLUMBING Ll SIGN <br /> w,�c��i�� 6UPAOQT���eu�cc-� Ro c�a�x g�o7 Z�P ���m_��E 9x2�1- 12�� <br /> 7EIUNT AURADDflE85 CITY 21P PNd/E � <br /> �4►JC� �0-SSb 33d�i CAs/�D 2�Pm 5 � EVE2�rt',vOA <br /> NICNITECTd10E4qNER MARAOUNESS - CITY 21P PIIONE <br /> OE1I� f(XI��T011�� ' WRADDRESS CITY 21P �PIIOflE�02 ST�AT,E�JA-1/2� <br /> J� Y l lc L'I ' A��A�'.� AN E E C = lf_ <br /> MECIWIM'dLCONTMCTOfl AUILA0011E�p CITY IIP PIIONE BTATELICENSE/ <br /> ��,��1 CD Yb�ti1L �''ifr7 .J�hT�F a$12�1- ']b233// MCk�N�ri'f3�s�1�0 <br /> � PLWBfqCONTpACTOR AUIL�ODRE S GITY ZIP PHCNE ST�TEIICENSEI <br /> �,�.�,��„� ov <br /> Q ^ <br /> DEBCfl6E WOIMf I1ND SIXIMIE FOOT�6E INVOlVEO CONT�CT 1'ERCiON N/O PIIONE NO. <br /> d: !�� 2 - 3 /l <br /> i HEflEBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnoroseouseaeu�oMa �, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � ' PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TVPE OP <br /> � lEdLLOEHCIqPTIONOFPROPERTV�9NOWNBELOWM�TTACHiWOCOPIES) `NORK WILL BE COMPLETED WITM WHETHER SPEGFIED HEREIN OR <br /> NOT. THE OHANTINO OF A PERMIT DOES NOT PRESUME TO aIYE <br /> ioT e�ooK a AUTHORITV TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> ' OTHER STATE OR LOCAL LAW REOULATING CONSTRUCTION OH THE <br /> y. PEPFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> VMCEL TIUf LD.NUMBEN CONTA TORS LA 1 .27�296200 WAC. <br /> y� �pNgTR�Ci1pNlWNlENOER.MdiESS.TElEP110NENUGBER A <br /> i y <br /> PROJECT AD S5 """ � °"` <br /> 4{ cnr euswEss�c[raE ru <br /> '.� � KUIMNW MIECNANICAL <br /> � �Ip, TYPE dF FlIfTURE OR ITEM FEE N0. TYPE OF EOUIPMffNT fEE . ..-� <br /> WATER CLOSET(TOILET) � MC�AMNDLG UNITS—H.P. � i�a>� <br /> � g�7►{7�Jg ' FOHCED AIR SVSTEMS—B.T.U. M E.A. ' ; ��^ <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � � •'���:4. <br /> �S gFpyyEp � CLOTHES DRYEF.S ' <br /> r KITCHEN SINK 8 DISP � � VENTILATION FAN � <br /> k . DISHWASHER � RANOE HOOD � <br /> 1 LAUNDRV TRAY ; WATER HEATER ' <br /> E CIOTMES WASHER � WOOD STOVE � <br /> _ �q��� � METAL FIREPLACE(WOOD BURNINO) � <br /> DRINKINO FOUNTAIN � FIREPIACE INSERT � <br /> F100R DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTEHS ; GAS PIPINO _ _ � <br /> _�; ROOF DRAINS—RAINLEADEHS � EXHAUST FAN � <br /> 31NK(SEHVICE—BAR,ETC.) • ; � <br /> ' I � <br /> : ;' I � ' <br /> � � <br /> � <br /> ' � , � <br /> , � <br /> SUB TOTAL S � SUB TOTAL { ' <br /> PFRMIT S � PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> � FOR OFFICE USE ONLY: <br /> FppH�g�g� qQ�q�7g/�K 61�ESEIBACN PIANCNECN YBE FEE RECEWTNO. <br /> ' ��� �oT/w� VACNlT61TE fEE VAIUATION FEE <br /> C] VES ❑ NO BUILDINO � <br /> ; trrcacaac ra.aFSTonies acu...cv ,oao+,u+au.�n � <br /> � �� PLUMBING i <br /> i <br /> gQEpp9�pp, FIflEfiPNC11cLER5RE0'0 B�SEMENT MECHANICAL ' <br /> ❑ ves n No � <br /> � p�pp�µ;y�p�p FIflEALAfWBEOD HEIUNTLIMIUTION ADDITIONALPUNCHECK i <br /> � <br /> OTNER � <br /> � <br /> HEASON � <br /> STATE BU�LDINO SURCHAROE � <br /> wTuc�er PLANSAPP(10VEDBY CITYOFEVEflETT PUULICWORNS ; <br /> •,IM LOCAL SALES , <br /> oerE n TAX COUE IS 3/05 roru ; <br />