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E I • � <br /> CITY HALL 259�8745 <br /> eveFerr.wn sezoi ❑ COMBINATfON ❑ BUILDING ❑ MECHANICAL � PLUMBING <br /> OwNEP <br /> MAII FDDRE55 LITY ZIP PHONE <br /> Jack M. Henry 1802 Dull Pla.ce 98203 355-3189 I/� <br /> APCHITEGT OR DESIGNER MAIL A]Ofi"e55 <br /> CITY ZIP PHONE ty�, <br /> GENERNLCCNTRACTOfl MAILFDDRESS CITY ZIP PHONE UCENSEI <br /> � ' IAEGMPWCALCANTRACTOP MAILADDRE55 CIiY 21P PMONE LICENSE� <br /> PWMBINGCANTRNCTOR - MAILA�ORE55 CiTY ZIP PHONE UCENSE� <br /> Same <br /> C1A550F WORK <br /> ❑NEV✓ ❑ADDITION ❑ALTERATION CIF7EPAIR ❑DEMOLITION ❑FENCL ❑SIGN GARAGE <br /> VALUATION OF WORK <br /> E <br /> OESCflIBE WORK <br /> PROPOSED USE OF 6UILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> LEGALDESCPIPTIONOFPROPERTY�SNOW9EL0'NOPATTACNFOURC/JPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVFRNING THIS <br /> �or BLOCiC_OF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOl.ATE OR CANCEL THE PRO� <br /> VISIONS OF ANY OTHER STATE OR LCCAL LAW REGULATING <br /> CONSTRUCTION OR THE PEHFORMANCE OF CONSTRUCTION. <br /> SIGNFTUnEOFGONTP CTOqORnU1NORIZE4 AGENT PAJE 9/al <br /> JO�FD�RE55 _ ^ �--�/ 1/1 <br /> 1609 Lombard X '���a�� <br /> PLUMBING M C NICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EDUIPMENT FEE <br /> WATER CLOSEi(fOILET) AIR COND.UNITS—H.P.EA. <br /> BATHTUB REFRIGERATION UNITS—H.P.EA <br /> 1 LAVATORY(WASH�ASIN) BOILERS—H.P.EA. <br /> GAS FIRED AA.UNITS—TONNFGE EA. <br /> SHOWER <br /> 1 Y.ITCHEN SIIJK 6 DISP. FORCED AIR SYSTEM1IS—B.T.U. M EA. <br /> VlALL HEATERS—B.T.U. �+� <br /> DISHN'ASHER <br /> LAUNDRYTRAV <br /> UNITHEATERS—BT.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> 1 WATER HEATER CLOTHES DftYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN RANGE HOOD <br /> AIR HANDLING UNIT— C.F.�d. <br /> FLOOR DR�IN <br /> VACUUh18REAKERS STOVE <br /> ROOF DRAINS—RAWLEADERS MEiAL FIREPLACE 8 CHIMNEY <br /> SINK(SEFVICE—BAR.ETC.) <br /> SUBTOTAL S <br /> SUBTOTAL s <br /> PEFMIT S PEPMIT <br /> TOTALFEE 5 TOTALFEE 3 <br /> PLAN CHECK FEE <br /> SIDE�ARD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER FEE FECEIPT NO. <br /> USE ZONE LGT AREA VACANT SITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> 7YPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING � <br /> SIZE OF BLDG. NO.OF STORIES MA%.OCC.LOAD 13 00 <br /> PLUMBING <br /> FIRE ZONE BASF.MENT FIR[SPRINFLERS MECHANICAL <br /> RE�UIRED <br /> ❑YES ❑NO <br /> APPPOVALS <br /> BY DATE OTHER <br /> 1. ENVIRONMENTALCHECKLIST PENALTY UBC. <br /> SEC.3031a) <br /> 2. BUILDINGFlANS T�TA� 13 00 <br /> 3. FIRE HYDRANT <br /> PERMIT VA�IOATION <br /> 4 FIRE PROTEiCTION SYSTEM WHEN PROPERLY VALIDATED QN THIS SPACE)THIS IS VOUR PERMIT <br /> 5. GRADING Y � i G � IJ I J. O O — � <br /> 6. DRAINAGE � <br /> 7. ENVIRONAtENTAL IMPACT STATEMEN7 � <br /> B. HE�LTH CISTRICT . , ,�, . �^ �_ I PT O <br /> APPLICATION ACC.BY FLANS CHECKED BY APPF. FOR ISSUANCE BY J U <br /> d;� � <br /> 4DDRE55 FILE i � ,i.;r i; ; <br />