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APPLfCATiC� FOR CONSTRUCT�N PERIIAiT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATINr,SYSTEM: C]GAS U ELECTRIC ❑ <br /> BUILDING DEPARTh'=NT <br /> 259-8810 <br /> I I DEMOLITION ❑ COMBINATI011 l�BUILDING I l MECHANICAL I_t PLUMBING ❑ SIGN <br /> OWNEH MAILADORE55 GITV 21P PMONE ��C/�r <br /> �'Nr�t�i, cc� �308 L�hMMEX�CiP(� �.vr- 7 353— r <br /> iENANT MAILADORESS CITY ZIP ^NONE <br /> pRCHITECTORDE5IGNER MAILADJRE55 GTV 21P PIIONE <br /> OENERAIf,ONiRACTOR MAILAUDRE55 CITY ZIP PHONE STATELIGENSEt <br /> ��Acay C� r� i���� �1„JAde r� � �i��Jc i�z7/ lS2 'l�d� �,,ncoYc a77o� <br /> MECHANICALCONTPACTOfl MRILAODHESS <br /> CITY ZIP PNONE ST�TELICENSEC <br /> PLUMBINGCGN'IRACTOR MFILADDRESS <br /> CI1V ZIP PHONE STATE LICENSE I <br /> CONiNACT PRICE OF WOPK <br /> �.SLf(1 ``— - <br /> �ESCRIBE WORN AND SOUARE FOOiAQE INVOLVEU CONTACT PERSON PND PHONE NO. �'��a�/ /�'] �j (J/ <br /> / (7 L b <br /> �UnJOA?vr.� ��25 l o -- <br /> ��Sr�N� . � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUIl01NG APPLICATION AND KNOW THE SAME TO BE Ti'iUE AND CORRECT.ALL <br /> PFOVISIONS OF LAWS AND ORDINAtJCES GJVERNING THIS TYPE OF <br /> IEGAlDESCHIPTIONOFPROPERTV(SHOWNBELOWORATfACNTWOCOPIES� NOT THELGRA TOING OF AD ERMITJDOES NOT PRIESUME TO GIOVE <br /> ��T o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION UR THE <br /> PERFORMANCE OF CONSTRUCTION.THsT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEf:TY TO PERF� 9M THE WOHK FOR WHICH <br /> APPLICATION IS MADE AND � COMPLY WITH THE STATE <br /> P�RCELTA%I.D.NUMBER CONTRACTORS LAW 18.27 RCY!AND 296200�NAC. <br /> CONSTRUCTIONLO�NLENDER,AODRESS.TELEPHONENUMBER �`/� 5 �J ' I � <br /> � y <br /> $IGNRUPE oe,re <br /> PROJECT ADDRESS6.�A � dnl _C/A G.. N�. —'- <br /> CITY BUSINESSI�LENSE 1A <br /> PLUMBING MECHANICAL — <br /> FEE N0. TYPE OF EOUIPMENT �E <br /> NO. TttFE OF FlXTURE OR ITEM q��q�HNDLG UNITS-H.P. ' <br /> WATER CLOSET(TOILE� ' � <br /> BATHTUB ' FORCcD AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M � <br /> SHOWER ' CLOTHES ORYERS � <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL ; <br /> DRI�KING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS-�RAINLEADERS � EXHAUST FAN _ ' <br /> SINK(SERVICE-BAR,ETC.) � ; <br /> � <br /> �— � <br /> � SUB TOTAL S 1' <br /> SUB TOTAL S � pERM1T 5 � <br /> PEPMIT 5 � TOTAL FEE $ '_ <br /> TOTAL FEE S � <br /> FOR OFFICE USE ONLY: aeeeirT No. — <br /> P�AN CHECN NUMBER FEE <br /> FRONTSETBACK REARSETBnCK S�DEShtBACI( D <br /> ��l <br /> VACANTS�TE FEES VALUATION FEE <br /> USEZONE LOTAREA s /� � �7� <br /> ❑ YES ❑ N� BUILDING 7 � � � �� <br /> lYPEOFCONST. NO.OFSTORIES acuou�cr xoaowtuincuxns i <br /> cnar pLUMBING ' <br /> S�ZE OF BIDG. FIRE SPRINKLERS REO'� AASEMENT MECHANICAL 1 <br /> ❑ YES ❑ NO � <br /> ADDITIONAL PLAN CHECK ' <br /> OCCUPANCY LOAD FIFE AURM REO'D 4EIGHT L�MIiATION � <br /> i <br /> O7HER ' <br /> i�� <br /> HEASW� STATE BUILOING SURCHARGE '� <br /> INTAKE BY P�NS pPP�7O�BY CITY OF EVEREIT PUBLIC WORKS � <br /> ^ �oca�sa�es �� J; .;� <br /> DATE <br /> TAX CODE IS 3105 TOT�� <br />