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APPLICATI� .1 FOR CONSTRUC7_JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: AS O ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I � DEMOLITION � COMBINATION BUILDING 9N�HANICAL PLUMBING SIGN <br /> pyMEp� ue ,NOPE55 [IiV bP FMME <br /> Jac /11ed4 �Pr i 33 /�=��n .E��r-�ff, v� Y&�d3 .�ic -,� s's-- 35',�-3 <br /> iEN�Ni �'4�0.�E55 IiV �P PIIGIE <br /> �RCNIiEL1CADE5MINEP MMAOURE55 LIiY I�F PNONE <br /> GEN[NIM1LONiP�CiOR uen��ORE55 Clrv Z�P M�OME SU1ElICExS[• <br /> MEGNIJIiL0.CONLR�CIOH MI.M1�WNE55 CRV 21P FIqNE SLAiEULFNSEI <br /> �vrcan /7is7�vL �'i..� � 38el,aio�+�a,c� �r,���� q���� aac.aro.tizc fJ/NfR�2'SS3dy <br /> 1'IUMBINGLONiPACTOF M�M1I.00FF.55 � CI1Y J ZIP PIKKIE SiALEI E SC <br /> CUSSOF W(N�R <br /> � NEW ✓AUDITIOH . ALiFRAT10N � REPAIR ' DEMOLITION �. � WOODSTOV6FRPLINSER? BWLDINGRELOCATION <br /> Cp1t�Gi PEfl$CN NI�VIKKI[NJ <br /> CON1R�CiPRILEOfRYMM �f��� <br /> p[$CRi9EWIX�Y.I.NDSOUAREiIXIi/.GEIryyC(a� ����, <br /> /�v � /.,^ u; <br /> rn roxouseoreunowo i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED iMIS <br /> APPLICATION AND KNOW iME SAME TO BE TRUE AND CORflECT ALL <br /> �ecn�oesca�=iro�+ovoporennis��owneciowoner*ecn�wncovi¢si PROVISIONSOFIAWSANDOR�INANCESGOVERNMGTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> m� eioce � NOT.THE GRANTING OF A PERMIT DOES NDT PFESUME TO GNE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LA�Y REGULATING CONSTPUCTION OR THE <br /> PERFORMANCE OF CONSTFUCTION.TNAT I AM AUTMORIZEO BV iME <br /> OWNER OF TIiIS PROPERTV TO PERFORM THE WORK FOR WHICIi <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTOR U+W18.27RCWAND29G200WAC <br /> . �� �S� <br /> n•rz <br /> PIKUCLiADDf1E55 /�� _�_x1 N— Q <br /> S' <br /> PLUMBING MECHRNIC�L � <br /> Np, TYPEOFFIXTUREORITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATER CLOSET i1��LET) NC—AHNDLG UNITS—H P <br /> BATNTUB FOflCEDAIRSYSTEMS—BT.U. M EA. <br /> 1.AVATORY�WASHOASIN) UNITHEATERS—BT.U. M _ <br /> SMOWEfl CLOiHESDRYEFiS <br /> KITCHEN SINK 8 DISP VENTILA110N FAN �� <br /> DISHWASHEFl RANGE HOOD <br /> LAUNDRY7RAV WATERNEATER <br /> CLOTMES WASHER WOOD 510VE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIFEPLACE INSERi <br /> FLOOR ORdIN NEAT PUMP <br /> BACNFLOW PREVENTEfl$ GAS PIPING _ <br /> flOOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SEPVICE—BAH,ETC.) <br /> SUBTOTAL E SUBTOTAL S / — <br /> PERMIT S PERMIi S � <br /> TOTALFEE E TOTALFEE S � � <br /> FOR OFFICE USE ONLY: <br /> iPpNiS[19I�CN RE�RSEiBACR S�OCS[iBALN R�NCHEC N A� �EE PEGEIViNO <br /> ���'=�= <br /> ���i io*�nee vncwrv*e FEES VRLU�TON FEE <br /> ewioir+c <br /> nxawxisuiaw.o�� rstacm1sr.ciuu � ,ona.,,�:.c�.,,, <br /> PLUI.IBING <br /> 6QEOiBlDO NO O�SlppiES BASkMENf MECMANICRL <br /> Of:CUPAIICYWAO RPESFNHNLENSNEOO MEGNfL141ILiK11 <br /> AO�ITiONAL PUN CMECN <br /> SPPiNNLER <br /> PEASCN�OR SP11WMlEPS <br /> ST�TE BNLDING SURGNARGE <br /> MtAXEBY MNSAFP110VEDBY CITYOFEYEHETT PUBLILWOflKS <br /> LOC11L 511LES <br /> TAX CO�E IS 3105 TOT�L <br />