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��"�����1.f11 �O� ��Y'� everetl <br /> rn.e�.ro�«� C�'JNS�'RU�Tl�N <br /> crtr or � <br />:; �`rerett PERMIT � <br /> TC�8E COMPLF_TED IN BLA.^.K INK- PLEASE PRINT <br /> BUIL.DING �EPT. <br /> 253•9745 COM9111ATION � BUILDlIJG ❑ MECHANICAL ❑ PL.UMBING ❑ S{GN <br /> OWHER A4�iLAu3PC55 CILV Z�a fHONI <br /> _"'`�'�" „� . Zn.rc.rtzr� �i�d� –3rd Auc. N,e� . �."T(�.,�_�/1�L 5�7-=Lo8S` <br /> AOGIII�ECi RpE910N! P MAILAO�NES'! CIIY LIP —� PHONE <br /> GENER�LGONiPApOR MMI.AGORE55 CIIV ZIP PIIONE LILFuSE� <br /> SAt.n tt' <br /> MECIUNIC�ICONiPA[fpq i.IRIL��OCE55 CITV 21P VIIONE LiC[��SE• <br /> PLUMO�N.CONIR�CtOF MAILAD�RE55 CIIV EiP PIIOhE ULENSE• <br /> �C �`S Oi WO11N <br /> �_ NEW ❑ AfiDITION ALTERATION � REPAIfl ❑ OEMOLITIOPI ❑ WOODSTOVE/FRPL.INSERT ❑ BWLDING RELOCATION <br /> � »__ <br /> JA WAIIC40f WORK�f.�r f C F MA{I[\f P l$PLUS U80P) <br /> ��'���./ _— <br /> uEscn:uE onK <br /> �e„-�a.;�' - r,� - C l,t�,��,o ' k1�F �G C'o . — <br /> �;eovaucort+a � <br /> � i !1EFEBY CERTIFY THAT I HAVE READ AND EXAAtINED TI�i15 AP� <br /> OF 1-'IC.I:�_ PLICATION AND KNOW THE SAME TO BE TRUEANO CORRECT.4LL <br /> IEWLDESGRIPiIONOFPROPE11tY�5H0YlNBELOWOFnTiPCHFOUPCOPIES� pqpVISIONSOFIAWSANDORDINANCESGOVEP.NINGTHISTYPE <br /> OF WORK WILL BE COMPLETF_D WITH WHETHER.^iPECIFIED HEf7E• <br /> ior—e�oc�._ur_. IN OR NOT.THE GRAN fING OF A PEPMIT DOES NOT PRESUIdE TO <br /> GIVF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATF OR IOCAL LAW REGULATING CONSTRUCTION <br /> �— OR THE PEA�ORMANCE OF CONSTRUCT�ON. <br /> SIGNAI O OMfi�CTORORAUIII RR AGENi �A7G <br /> X C2,�.�=, � �, � r "- .��1�i�'t <br /> PROJ[Cl/.pORE55 RPPLIC�N SC YOUSiNI a�LIC[I�SE NO ,}� <br /> s�.TL az o /" <br /> 1p�lJ s.E rV�e.11 vvl-lI WGy - ----- <br /> PLUMBING MECHANICAL _ _ <br /> NO. TYPE OF FI%TUflE FEE NO. TV{`E OF EUUIPMEN� FEE <br /> Wq7ER CLOSET(TOIIET) Alfi COND.11N1T5-H.P.EA. _ <br /> BATH7UB REFRIGERATION UNITS-H.P. EA _ _ <br /> LAVATORY(WASH BASIN� BOILERS-fi.P.EA. __ <br /> SHOWER GAS FIREO AC.UNITS-TONNAGG EA ____ , <br /> KITCHEN SIIJK 8 DISP. fORCED AIF SYSTEMS-8.1.U. M EA. <br /> DISHWASHER WALLHEATERS-6.T.U. A1 <br /> LAUNDRY TPhV UNIT HEATERS-B.T.U. hi _ <br /> CLOTHES WASHER _ EVAPOflATIVECOOLERS _- <br /> WATER HEATER _ CLOTHES�RVERS ___ <br /> URINAL VENTILl.TION FAN ____ <br /> �RINKING FOUNTAIN FANGE HnOD — <br /> FLOOR�RAIH _ AIR MANJLING UNIT- QF.M. _ _ <br /> VACUUM f1iiEAKERS _ STOVE -— <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE 8 CHIMNEV __ <br /> S�NK SERVICE-BAR,ETC. ��NOODSTOVE/FIAEPLACE INSERT <br /> SUB TOTAL SUBTOTAL 5 <br /> PERMIT 't PERMIT 5 <br /> TOTAL FEE f TOTAL FEE 5 ___ <br /> TFIIS PORTION TO BE COMPLE"iED BY BUILDING DEPT. PtNSONNEL <br /> fBON�5E18�CN il[RRSEt04CN SIDESETPACN PLANGHECKNU 10EN PlnNC11ECHfEE <br /> N. /� T � ti FEE� j � f1E4c{��-tY G..'i iJ/ <br /> �-� � <br /> (% � <br /> US[LONE lOitOCA,.� ❑ESN�`!O FEES �ALUATION fEE <br /> G�( N — � <br /> IYPF.OFCON51. OCCUPN1GYGf10UP NO.OiOV�ELCINGUNIT3 <br /> P��L. � �C7 <br /> � � �Q, _ ni;i�nra� S 3 �— �"7 <br /> SIZE O�OLOU ��C.OF SL"f�NES MA%OCQ LOAD — <br /> �'100 5F 4 3� FIUM�ING _— _ �2 _D?� <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑1'ES L'Y�JO I <br /> — OTHER <br /> PEIIACTY <br /> RPPIiCAtIONACC.BY PU��$JNEGNED BY ��'pri.FOf1�3SURIGE UY — � �r1 <br /> Jvl � � fOTAI ___ ��, <br /> J �.. • <br />