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Don Tollefson 6901 Lombard 98203 353-335U <br />nHCNIiEGT OR DEoiGNER MRIL ADDRE55 CITY ZIP PHJNE <br />GENERAL CONTRACTOiI MAI� A�DRE55 GiTY ZiP PH011E LiCENSE 0 <br />Same <br />NECHANILALfANTFACTOR MAILADDfiE55 CITY ZIP PNON[ �ICENSE♦ <br />Pl9MBINGCONTRACTOF MRILAOOPE55 Lltt .'IP Ph'ONE UGENSE/ <br />C1A55 OF V10RN <br />❑NEW ❑ADDITION ❑ALTERATION '"�REPAIR ❑DEMOLITION ❑FFP:CE ❑SIGN ❑GARAGE <br />\".WATION OF WOFK <br />E <br />DESGFIBE WORK <br />PPOi�OSED USE OL BUILOR 9 <br />install wood stove <br />LEGt L DESGRIFTION OF PROPEPTY �SMOY! BELOVI <br />�or e�a�_o� <br />6901 <br />PLUMBING <br />NO. <br />WATER <br />rd <br />TYPE OF FIXTVRE OR <br />KITCHEH SINK & DIS�'. <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DFINKING fOUNTAII <br />FLOOR DRAIN <br />VACUt1M BREAKERS <br />ROOF DRAI�S — RA <br />SINK ISERVICF — Bf <br />SIDE YARD SEl <br />USEZONE <br />TYPE CF CONS <br />SIZE OF BLDG. <br />FIRE ZONE <br />TOTAL <br />STREE7 SETBACK <br />ST9RIE5 <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUiLDING PLANS <br />� <br />3. FIRE HVORANT <br />4. FIRE PRCTEC'ION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIFONMENTALIMPAC757ATEMENT <br />0. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />I HEREBY CERTIF'Y THAT I HAVE READ AND EXAMINED THIS AP- <br />coPiEs� PLICATION AND KNOW THE SAME TO LiE TRUE ANG COFFECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNINU THIS <br />TYPE OF WORK WILL BE COMPLIED �NITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TFic PHO� <br />VISIONS OF ANY OTHER £,TATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORNANCE OF CONSTRUCTION. <br />SIG'1 REOFCONiPACTORORFNMORIZEDAGENT DAiE <br />X �,�,",y�%� � % 11�13 80 <br />FEE <br />REAR YARD SI <br />VACANT SITE <br />❑YES ❑NO <br />TYPE OF EOU'� <br />AIR COND. UNITS — M.P. EA. <br />REFPIGERATION UNITS — H. <br />001LER5 — H.P. EA. <br />GAS FIHEU A.C. UNITS — TO <br />FORCGD AIR SYSTEMS — B] <br />WALL HEATEFS — 8 T.U. <br />i INIT HFATFRS — B T.U. <br />RANGE <br />'ELLING UNI7S <br />BUILDING <br />LOAD <br />PLUMBING <br />.ra <br />N'HEN <br />APPR.FORISSUANCE �Y <br />UNIT — <br />EA. <br />M EA. <br />1L FEE <br />FEE <br />5 <br />u.e o. <br />SEG. 303 (a) <br />FEE <br />FEE <br />RECEIPT NO. <br />FEE <br />7m <br />Y VALIDATED (IN THIS SPACE) THIS IS YOUR 7ERbt1T <br />���ta9 �007.50—,`� <br />t.i> <br />� <br />, , - ;, _. � , „T o <br />,�. ... � � <br />,,.,,,, }., iJ <br />-.: r. <br />ADDRE55 FILE I � i J'J u l; <br />