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ill ' <br />APPLICATION FOk. ' evereH <br />the CITY OF CONSTRUCTION <br />CONSTRUCTION � C <br />ever ett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OYMEII MAIL ADDRESS CITY y `y IIP PHONE T <br />D.K-�FVG�FYI MALL Wow E4Etf T ii(n-3Ias <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PNO\' <br />ADDRESS CITY ZIP PHONE LICLNSL A <br />ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR MALL ADDRESS CUY ZIP PHONE LICENSE <br />CLAS `WORK BY NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK( CC T Of IIIA. ERIALS PLUS tABOn1-- <br />�ta`-1 <br />DESCRIBE WORM <br />USE OF BUILDING --p,ETf" <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />S_r>� - <br />PLICATIONAND KNOWTHESAMETOBETRUEAND CORRECT.ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LUT_BLOCK _OF <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 />— <br />SIGNATUR .OF ONTRACTOR OH AUTIIORIZEO AGENT GATE <br />X <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPt OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET(TC;LET) <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-1-I.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHCWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER _ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />— <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS- RAI NLEADERS <br />METAL FIREPLACE& CHIMNEY <br />_ <br />31NK �•ERVICE-BAR ETGI <br />WOOOSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL 5 <br />_ <br />PERMIT $ <br />PERMIT 5 <br />TOTAL FEE '+ I <br />I TOTAL FEE 5 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN f,HECK FEE <br />I PEE RECEIPT NO. <br />USEZONE <br />wlnnc^ <br />VACANT SITE <br />OYES ONO <br />TYPE OF CONST. <br />OCCUPANCY GRGUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG. <br />NO. OF SIORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />PLPNS CIIECKEO BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />FEES I VALUATION I FEE <br />5 <br />