Laserfiche WebLink
r <br />file Ewrgr"n <br />OF <br />CITY <br />BUILDING DEPARTMENT <br />259.8810 <br />I 'ia <br />h►'PPLICATION FOk;) <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION EYBUILDING O MECHANICAL ❑ PLUMBING <br />%I O MAIL ADDRESS CITY ZIP PHONE <br />0 U l�fA/ (09�7 ��a�^o�-ePyurt�u z P 711 9dzo.3 . _F� 7�- <br />evereR <br />e. <br />C <br />- <br />AR ITECT OR DESIGNED <br />MAIL ADDDESSn <br />Z GIIY <br />ZIP <br />PHONE <br />7-o d /�• <br />ArC�T'�P�� Tezllzli <br />7y9[(yIy-: <br />e25Fs 3a3� <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CIFY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSEi <br />CLASS OF WORK -- <br />❑ NEW ADDITION ❑ ALTERATION �SREPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />/0 yap <br />DES IBE WORK <br />c -4, Gii / 1 f� �o�fa� iii�4✓ . ��/���, 7:.2�riai,� A �✓ li. L , <br />SE of awe . <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- " <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOFLAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE O - CONTRACTOR OR AUTHORIZED AGENT RATE <br />X <br />LEGASCRIPTION OFPROPERTY(SHOWNBELOW ORATTACH FOUR COPIES) <br />LOT 17--BLOCK_ oT <br />' <br />PROJECTADDRESS <br />APPLICANTS CITY BUSINESS LICENO <br />PLUMBING 7 7-7 <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNOLG UNITS - H P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS - B.T.U./H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS - B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />HEATERS-T B.T.U. M <br />LAUNDRY TRAY <br />I <br />UNIT HEATERS - .T.U. M <br />CLOTHES I/ASHER <br />EVAPORATIVECOOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGEHOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOODSTOVE <br />SINK (SERVICE -BAR. ETC.) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />NEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />i <br />SUBTOTAL <br />PERMIT <br />f <br />A PERMIT <br />TOTALFEE <br />S <br />TOTALFEE <br />PLAN CH CK NUMBER <br />acos 3 <br />FEE <br />n�fj-- <br />RECEIPT NO. <br />q767 <br />FRONT SETBACK <br />REAR SETBACK <br />- <br />SIDE SETBACK <br />— <br />USE ZOr <br />T� <br />LOTAnEA <br />/S 1 <br />VACANT NE <br />CYES+o <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE O[_CgNST <br />' ,y'N <br />OCCUPANCYGROUP <br />e ^ 7i <br />NO OF DWFLL ING UI... S <br />-'B' <br />PLUMBING <br />SIZE OF 0L00 <br />.L�� I `•t <br />.J T <br />NO OF STORIES <br />MAX. OCC. LOAD <br />�� <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES 0 <br />OTHER <br />STATE BUILDING SURCHARGE <br />APPLICATIONACC BY PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />ak 12, �, A - <br />►A.Y�' <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />Z1 <br />PROPERTY OWNERS ARE RESPONSIBLE FUR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />