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� � APPLICATIC�1 FOR CONSTRIi�CT ^�N PERMIT �� <br /> TO SE COMPLETED IN BLACK INK—PLEASE PRINT � • <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑_ � <br /> BUILDING DEPARTMENT — <br /> 259•84 i 0 <br /> ❑ DEMOLITION ❑ COMBINATION i I BUILDING CI MECHANICAL L�PLUM9ING I ; SiGM1G <br /> OWNER MAILA�DflESS CITY ZIP PKONE <br /> l.�n A I � � W���' �"' �Jeac�T wq. ��c 3 �S9-a��/� <br /> �03C{C� 1 ���V�pZ- '1 I I � V'�"e.l ZIP PIIONE <br /> � ITY 21P��'e Fr10�`J��Zr�� <br /> ARCHITECTORDE'aIGNER �AILADORESS � <br /> G:NERFL OIlTRACTOFl MAIL PDDRESS G�TV 21F P�iONE STATE LICENSE t <br /> MEGHANICAL�pACTOB� MAILAU�RESS LRV 21P PMO`!E STATELICENSEM <br /> PLUMBINGCONTRACTOR MAILADDRESS CIN ZIP PHONE £TATEUCENSEN <br /> CLASS OF WORK <br /> L I NEW Ll ADDITION I 1 ALTE 1ATION I I REPAIR . I DEMOLITION i i WOOUSTOVE/FRPL INSERT . � BUILDWG RELOCATIUN <br /> / GONTACT PER ON AND PHONL NO <br /> ,/ � U ^ � <br /> CONTRACT PqICE OF WORN <br /> �ESCRI WOFKANDSOl1PREF AGEINVOLVED C -+�`�t -�^�'�'�"e"' — <br /> -a.cw-.-i`- -r/.-�--rx1-.✓G <br /> PROPOSE�USEOFBUy�NG i HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> C,` ;\ ; 1, —;A JQ�l APPLICATION AND KNOV!THE SAME TO BE TRUE AND CORRECT.ALL <br /> r�' ��G� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIFTIONOFPROPERTV�SHOWNBELOWOflATiACHFOUflCOFIES� yyORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESIIME TO GIVE <br /> AUTHORITY l'O VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATG OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMAt10E OF CONSTRUCTION.THAT I AM AUTHORIZED B'V THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR NIHICH <br /> APPLICAiION IS MADE ND I COMPLV WITH THE STATE <br /> RS LA 827 R W AN ^e96.200 WAC. <br /> v � <br /> SIGNAIURE ORtE <br /> PRQIEGTADDRE55 /D J <br /> � 2 Cltt!iU5ME55V4EN5EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXI'URE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/�A�HNDLG UNITS—H.P. � <br /> BATHTUB ; � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � IINIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS � <br /> KI?CHEN SINK 8 DISP � VENTILATION FAN � _ <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNE ' <br /> DRINKING FOUNTA�N � FIREPLACE INSERT � <br /> FLOOR DRA�N � HEAT PUMP ' <br /> B.4CKFLOW PRE NTERS I GAS PIPING � <br /> HOOF DRAI —RAINLEADERS � EXHAUST FAN ' <br /> SINK(SE ICE—BAR,ETC.) � <br /> � ' <br /> � <br /> SUB TOTAL $ ; SU6 TOTAL S ; <br /> PERMIT $ � PERMIT $ � _ <br /> TOTAL FEE 5 ' TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSET5ACK REARSETBACK SIDESElBPCK PLAKCHEGNNUMBEH FEE RECEIPTNO. <br /> _ .�,�ya l .s� ��'� s <br /> usezoNe LOTAREA VACANTSITc FEES VALUATION FEE <br /> Q'� � <br /> 6UILDING � ' �G <br /> TYPEOFCONIS.ALLONABIE TYPEOFCONSTAC7UAL octUva!:cr NaOimvEluNGurn15 � <br /> caow �� PLUMBING � <br /> �_ �N 2. ' <br /> i <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL � <br /> ��i� -ri . r ti'� , <br /> .7CCUPANCY LOAO FIRE SPflNKLERS flE0'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> � y� i <br /> 2� /"" SPRINKLER i_ <br /> REASON FOR S�RINKLERS � <br /> STATE BUILOMG SURCHARGE � � �� <br /> i <br /> INTANE BV PLANS AFPROVED BV CITY OF EVEREIT FUBLIC WORKS <br /> LOCAL SRLES � <br /> � � 9� � TAX CODE IS 3505 TOTAL /y , Sa <br />