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APPl.ICATIO�FOR CONSTRUCTI�1 PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ��DINGDEPAfl T ' / HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑ � <br /> zss-se�o ���� �/Qryl,� 272� � �1D/ � <br /> ❑ DEMOLITION ❑ CdhiBINATION ❑ BUILDINfi MECHANICAL O PLUMBINO SI�N <br /> OMNEH Y�LADqi[55 CIfV ZIP hbNE <br /> C� 277� fnlbyAvE F�•+�t 98�� 9rS 3o3-3N87 <br /> rexyy wy�� ncss cm zio r+�ax <br /> , 1" ,nli e,� .i IS ���Ja.�v <br /> ��R IX1�ESpMER M I�DDRE55 Cltt ZiP PNON[ <br /> G(NEPMCp1iR�CtOF MNL�OdiE55 G11Y 2�P PIUNE SI�IELCEH$E• <br /> ��Z.„,�niv.n�s N/2�E(�E17��1A9�/ ��eal 9�.os� yzs�vase� By�sr�o���a <br /> M CN1NiC LCNiPA iOq M�l/.Op1C51 C�C/b Gry ZIP OIN.`NE $i�iElCENSf� <br /> V�L <br /> p PLUYBNOCbN1ReCIDN IA/.4M011E55 CIIY S�V %�ONE SI�TELFENY• <br />� <br /> carta�cr kcawaa <br /> �(�� <br /> DCSLPREWdUANp6pU�REfWiAGEMVIXVEC CpIIACiPEN5q1�NOPNJNCIq. �'N t�NA,I <br /> /� I7i�i <br /> IN5T1x[. n(7N-�[ttv�iNq�1vAl1 S N Zs 3�a -ag s - <br /> ��KIO ' � �O'- SR,'('/ i t HEREBV CERTIFV THRT I HAVE READ ANC E%AMINED THIS <br /> rnovo5E�u5E weunD� APPLICATION AND KNOW TME SAME TO BE TRUE AND CORflECT.ALL <br /> '�S7p�JQA� PflOVI510NS OF LAWS AN�OHDINANCES GOVEHNING THIS TVPE OF <br /> 7 •.o�univrrorvarrno�[nrv�srqrmettavou�n�cxirocon¢5� WORK WILL BE COMPLETED WITM WHETHER SPECIFIED HEREIN OR <br /> � NOT.TME GR�NTINO OF A PEPMR DOES VOT PRESUME TO GIVE <br /> id* e�xe or AUTHORITY TO VIOLATE OR C/.NCEL 7HE PHOVISIONS OF ANV <br /> OTMER STATE OR LOCAL UW flEGULATING CONSTRUCTON OR THE <br /> PEPFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PEAFORM THE WORK FOR J/HICH <br /> APPLICATIOA IS MADE AND I COMPLV t'�ITH THE STATE <br /> anxc�tex i D r�uva[a CONTRA/CT�ORS lAW 1B 27 flCW AND 286200 WA;. ;;;�����p--- <br /> LONSi1X1CiKKILOANLEN�ER..N�PE55.i[LE%qNENUMBEN /J������— /(y ���AI <br /> .�� v I <br /> _ Y— / J <br /> PNOJECTADDXE55 � � ��^� (o(p'/ °"" Q' <br /> cm wssn as�c�.ss w 1' <br /> PLUMBING MECH�NIC�L <br /> NO. TYPEOFFl%TllREOHITEM FEE N0. TYPEOFEOUIPMEM FEE <br /> WATER CLOSET�TOILEi) NC�A�NNDLG UNITS—H.P. <br /> BATMTUO FORCEDAIRSVSTEMS—B�.U. M E.A. <br /> LAVATORV�WASNBASIN� UNITHEATEPS--B.TU. M <br /> SHOWER CLOTMESOFVERS <br /> KITCHEN SINN 8 DISP YENTILATION FAN <br /> DISHWASHER RRNGE MOOD <br /> LAUNORV TRAV WATER HEATER <br /> CLOTNES WASMER WOOD STOVE <br />� URINAL METALFIREPLACE�WOOOBURNING) <br /> DRINNING FOUNTAIN FIREPUCE INSERT <br /> FIOOR DFAIN MEAT PUMP <br />' BACKFLOW PREVENTERS GAS PIPING <br /> � ROOF DRAINS—RAMIEADERS E%HAUST FAN <br /> SINK ISEFVICE—BAR.ETC.� <br /> Sl1BTOTAL S SUBTOTAL f _ <br /> PERMIT S PERMIT S � <br /> TOTALFEE S TOTALFEE S I <br /> FOR OFFICE USE ONLY: <br /> tPOYt5E18�Cx PEApSEIBIiLK SIOESEfBACN PVJiCNELKMI40EF fEE NELE�PIIb <br /> usezoric iornnce vecu�tsirc FEES VALU�TION fEE � <br /> MEOf�3 il VES ❑ NO BWLDING �� <br /> 110.NSiCMIFS Omnq womumcunn I <br /> �� PWM91N6 <br /> SQEOFBl00. RPESFPA'MLEP9PE00 B�SEYfNi MEGH�NIG�I <br /> i i VES C NO <br /> vµ�vlOM iiNENAPURE09 NEK.N*liunAiqN �D�iT10NAlPUNCNECN <br /> OiNER <br /> 11EASIXi —T <br /> STQ[BVIIpING WRCHARGE <br /> iNiexEBv i'UHS 90�40BY CITYOFEVEBETT PpBLICWOfiNS <br /> %j� LOC�L S�LES <br /> o. � .�a,Gs TIIXCODE153105 roT�� <br />