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APPLICATI�N FOFk CONSTRU�TION PERMIT � <br /> — -` TO BE C9MPLETED IN BLACK INK—PLEASE PHINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTfNENT - <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILD!":G MECHANlCAL y�PLUMBING SIGN <br /> � '� OMMER ' IAAILRDOflE55 �r�'7'v�/���t PHONE <br /> v� <br /> �eo �1u11" b�aid Anr/ersax �/iERL- 77� � o� 3y7-�&2Q �S2-'-�OSo <br /> � H TENM1NT �. /� MnP_nODRE55 CITY ZiP PHONE <br /> >Hy _�Cw/ C�('G'lia4 i)`��� ��� �iy7f� S� `n��ll^�Lf��) L(//< <<�.J ��-C�'U� <br /> ARLMRELTOFD SI NER MAILAOORE55 • CITV ZIP PHONE <br /> y� H 7�� �i'n f o � �i��1c <br /> yC ('] GENEIIALGdJTRAGTOF A�A�LAppRE55 CITV 21P PHONE STATE�ICEM1SEa <br /> H 7tl <br /> �{I N �{I IdECNANICP�CONiPACTOR MAILMOPESS Cltt 21P PHONE STAtELICENSEI <br /> CA H <br /> C�+�' ,� PLUMBINGCONTAACTOA IAAILF�OflE55 CITY 21P PNO.YE STATELILENSEa <br /> W O � <br /> H <br /> QoHg — <br /> n GLAS501'WORK <br /> � n ! I NEN' ! I ADDITION '� I ALTERATION X REPAIR . DEMOLITION WOOOSTOVFJFRPL INSERT . i BUILDING RELOCATION <br /> CANTAQ PERSON A110 PHOIIE N0. <br /> s H� CONTRACT PRICE OF WOFK , <br /> r� T OESCfliBE{YOi1 NOSOUAREFOOTA EIN'JpLY <br /> g y y � ��f �/'<�.tarn.� � <br /> �ryy PROPOSEDUSEOFBIIILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �! APPLICATION AND KNOW THE SAME TO 9E TFUE AND CORRECT.ALL <br /> � LEGALDESCFIIPTIONOFPflOPERTV�SMOWNBELOWORATTALHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> yy WORK WILL BE COMPLETED WITH WHETHER SPECIFIEU HEREIN OR <br /> H O U7 �or BLOCK oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ' - AUTHORITY TO VIOLATE OR CANCEL THE PROVISICNS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> p � PERFORMANCE OF CONSTRUCTIOtJ.THAT I AM AUTHORI=ED BY THE <br /> t _ , , OWNER OF THIS PROPERTY TO PERFORM THE WORK I"OFi WHICH <br /> APPLICATION IS MADF. AND I COMPLY WITH TI1E STAT[ <br /> CONTRACTOR�LAW1827FCW ND2962(�"'NAC. <br /> x, /u .i'"..1���. �Ir J � .�' <br /> � - � aaaecrnooA=_ss "� ,'/ /�/ sa�ur , oere <br /> 1 1 � <br /> � �p�, � isU �(/7/ �G'�/���v�" cfrvnus�xcssi¢cvsExo <br /> PLUMBING MECHANICAL <br /> '�I NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEI: <br /> WATER CLOSET(TOILEn � AIC—IVHNDLG UNITS—H.P. � <br /> ' 1 BATHT!18 ' FORCED AIR SVSTEMS--B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M <br /> 1�' SHOWER � CLOTHES ORYERS <br /> '�1 KITCHEN SINK&DISP I — VENTILATION FAN __� <br /> DISHWASHER � RANGEHO00 � <br /> 1 ' LAUNDRYTflAY � WATERHEATER ' <br /> � CLO i HES WASHER W OOD STOV E �_ <br /> '� URINAL METAL FIREPLACE 8 CHIMNEV i_ <br /> � DRINKING FOUNTAIN FIREPLACE INSERT <br /> ' FLOOfl DRAIN � HEAT PUMP <br /> � E3ACI<FLOW PREVENTEFiS i GAS PIPING <br /> �1 ROOF DRAINS—RAINLEADERS � EXHAUST FAN i <br /> � SINK�SERVICE—BAR,ETC.) i— <br /> a/ — � <br /> � � <br /> ' SUBTOTAL 5 ,) ;— SUB TOTAL $ <br /> PERMIT 5 r _ PERMIT 5 <br /> �— TOTAL FEE $ /7 ;� TOTAL FCE 5 _ <br /> FOR OFFICE USE ONLY: <br /> FflONT5ET8ACH AEANSETBACN SI�ESETOFCN PLANf.HE KNUM�R FEIE PECEIPTNO. — <br /> 3��U <br /> usezorve IOTAREF vncanrsrt[ FEES VALUATION FEE <br /> i <br /> Ol11LDING ' <br /> tYPEOFCONLS.AILOtYABIE ttPEOfLCNSiACiIIAI dccucex[v xowPxauxcUxns ' � <br /> LP0°P � pWMBING i <br /> S�ZEOFOIDG. NO.OFSTORIES BASEMENT � <br /> MECHANICAL <br /> i <br /> OCCUPANCV LOAD FIRE SPflNNLERS REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> SPRINKLEP ' <br /> FEA��NFORSPRIHNL['iS 1 --� <br /> STATE BLILDING SURCHA9GE � <br /> — � <br /> INTAKEBV PUNSAPPROVE'10V CITYOFEVEflETT PUBLICII'ORKS i <br /> LOCAL SALES — <br /> TAX COOEIS 3105 T�TA� � <br />