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APPLICATlC 7 FOR CONSTRUCT' lN PERMI� � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPAATMENT HEATING SYSTEM: � GAS �J ELECTRIC �J <br /> 259-8810 <br /> DEMOLITION i C011ABINATION BUILDIyG /MECHANiCAL �pLUMBING SIGN <br /> ��'�'�t� n/�IAARpDOflESS y'�RY � ZIP PN011E <br /> TEN��V V' II "L/i�DDRE53�J ��--r_��/ C�/ ��_ ) �� JI l�h � <br /> � V � ZIP PHONE ^ � <br /> �1��—L_✓��� ,��� ; / ��iZ?�� ��� �/.� ��`�''� ���=L�"�c� <br /> nqCMl?ECTORpESiGNER IAA ApORE55 GTY 21P PHONE <br /> GENE ICONTRACiOR I.IAiLnD� E55 CITY I�P PHONE STATELICENSE <br /> ��,���%��-���-���D�i�f�-���i_����--Y�� A.��fi�,i�/o3� <br /> I.ECFa� CONiHqCiOF tdAl� �UaE55 GI 21P PII NE STATELIGENSEO <br /> PLII.'ddINC" p�T�TOR MFILADDRE55 CiiV ZIP PHONE STATELICENSE• <br /> 7� <br /> / ✓ <br /> CONiRACTPRICEOPWORK . <br /> -�c�0 � <br /> OESLPIAEWOfiKANO50UAREFOpTdGEINVOLVEP CONT/AC;`TPGRSONANDPfy�NENO / <br /> V �� �)�i � <br /> /�/%� ftiv H/ � <br /> I HEREBY C[RiIFY �fHP.T I HAVE READ A�lD EXAMINED THIS <br /> aRoaoseo use oF ew�o:Nc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT�LL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGaLDESCRIP7lONOFPFOPERTY�SNOWNBFLOWORATTACMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERERJ OR <br /> toT e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVL <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Oh 1NV <br /> OTHER STATE OF LOCAL lAW REGULATMG CONSTRUCTION OR iHE <br /> PEP.FORMANCE OF CONSTRUCTION.THAj�-f� AUTHORIZED BY 1 HF <br /> OWNER OF T R O PERFORM �E WORK FOR WHICH <br /> APPLIC N M �N I CO LY WITH THE STATE <br /> PAqLELTAXID NUMBER �-�, /��� /iD � CO ACTO � W A D 29 . 00 WAC. <br /> CONSIRUCTIONLOANLENLE .ApOFE55 T LE ONFNIIldpE . �?rr��- <br /> PROJECT ADDRESS r.r.nwar okrc <br /> f�n �5/ /� �i /��/ Fi� ��,.�,��s",�5s���,•:,,,.,� — —� <br /> PLUMB WG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE � NO. � TYPE OF EOUIPMENT __ FEE <br /> WATER CLOSET(iOILET) A-C—AMNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M ' <br /> SHOWER CLOTHE�DRYERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD —� <br /> . LAUNDRYTRAY � WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE <br /> � URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT�UMP � --T <br /> BACKFLOW PREVENTERS � GAS PIPING p <br /> ROOF DRAINS—RAINLEADERS EXHAUST fAN �/ <br /> SINK(SERVICE—BAR.ETC.) ; <br /> � 1 �— <br /> SUB TOTAL S SUB TOTAL $ <br /> PERMIT S PERMIT 5 <br /> TOTALFEE S ' TOTALFEE 5 i ~- <br /> FOR OFFICE USE ONLY: <br /> FqOf�iSETOFGK REAfi5E1BACK Si0E5�18ACK nLnNCiiFC�:tlUU9[� FEE F[GF.I �NO. <br /> use zor�e �oi naen VAGFNT SIiE FEES VALUATION FEE <br /> .^. YES ❑ NO BUILD!NG <br /> irfCOiCONSi. NOAFSTORiES a[va��icr xomwinuxcw�s — —' <br /> a9ouv p�U1.1�ING <br /> SVFOFBLDG FIRESPRIHNLERSREO'D BASEMENi MECHANICAL <br /> G YES :i NO — -- <br /> GCCUPANCVLOAD FIREAL�HAIPEOU HEIGHTLIMIiATION ADDITIONALPLANCHECK <br /> OTHER <br /> n[nsor+ <br /> STATE BUIIDING SURCHPRGE <br /> imnncnv auNsnrrnoveonv CITYOFEVfRETT PU�UCWORKS � <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 TOTAL <br />