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APPLICATIO' FOR CONSTRUCTI"N PERMIT r;�� <br /> TO BE COMPLETED IN BLACK INK—P�EASE PRINT 'C <br /> HEATING SYSTEM: ❑GAS rJ ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 � SIGN <br /> � "j' � Bl� D �y'P�i<"ri ��C�ANIO�� .d1i�r!�LUMBING � <br /> d DEMOLITION i:1 CpMBINA�'E;p.'1..� c., . � ��. +�� � ,,, . <br /> pV/1��1 MAIL ADDRE � �' J CITV Z{IP7^ ^ /�PyI//O�NE •-`J] Ry/� / <br /> li✓1��/i_�_.__� � M�I�DRE�C../-i/ V L7CT ( ��y'^`^-`^� 1 /C CN �vL��L.��W/T � F!/�DT _ <br /> TENRNT CITY ZIP PI10NE <br /> AHCHITECT OF DESIGNER <br /> MAIL ADDRESS CITY 2�P PHONE , '.:I i�l I' v� <br /> � . W <br /> CIiV ZIP PHONE . . . .•.�5T4TE I ENSEa .•. •.• •. . <br /> GENF��LCONTf�CTO� MAILADDRE55 � �� I �!I, � : •:' ''� � <br /> J`^'Na�� <br /> MAILAOORESS ��TY ZiP PHONE STATEUCENSEe <br /> MECHANICALCONTRACTOq ' ���� �"'� � � � �, <br /> PLUMBING CONTRACTOR <br /> MAILADDRESS CITV 21P P40NE STqTELiCF{N$E�:. u.l �J 1 <br /> CONTRACTPRICEOFWONR �, �i � �� . <br /> CONiACT PEFSON Ai1D PHONE NO. +��� � � •; , �. �i <br /> DESCRIBE WOflK AND SOUARE FOOiAGE INVOLVE� � <br /> Ili."�: I� i � li . <br /> yvwL v,� � � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> PROVISIONS OF LAWS AND ORDINANC�ES .I30VERNING THI$TVPE OF <br /> �ecnioescnirrwNOFraoaearv�sNowNee�owoRnrTncNnvocories�� � � � ' � WOFiK WILL BE COMPLETED WITN WH�7HER�SPEqFIED�HEFEIN'OR <br /> ;.� ., NOT..THE GRI�NTING.OF;q PERMlT�,�,DQ,Fy5;N0T PRESWME,TO GIVE <br /> �or — e��K oF � AUTHCRITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> � �y, `� s.�� � �„YJ /� �� �t� � � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION�OR THE <br /> /a- Y % PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI7ED�Y THE <br /> OWNER OF IS PROP�HfY'TO�P�RFd�IM��THE''WOIII(��OR�WHICH <br /> � c+> APPLICAT N IS MADE J�Np I COMPLY WITH�-�HE_�STATE <br /> PARCEL A%ID.NUMBER , ' CONT A � LAWiB.27IiCWAN6296.200 AG. i <br /> �(�!o-000 'c7(y'�� —000 � �f�/ —��^// <br /> C�yyCjl LO N LE DER.ADOR S.TE�EPHONE NUh10ER ///, T �-�,=sy <br /> � � O{% �/ <br /> (%� ' w�� <br /> PROJECT A DRESS � '.''•.,1 �s'4, ,n i'.;� � — <br /> (]� eareusmcssucenser+o <br /> NI Z`14�ANICAL <br /> pLUMBING <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0.I'� ��=1, TYPE OF EOUIPMENT F <br /> � WATER CLOSET(TOILET) � A/C—NHNDLC�UNITS—H.P. ' <br /> �'�'� ' '� 'FO�RCE�AIR SYSTEMS—B.T.U. M E.A. <br /> � BATHTUB � �- ; ; <br /> 1 LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> � CLOTHES DRYERS � <br /> � SHOWER ; <br /> ( KITCHENSINKBDISP - "'' � � ��� �� �� '� � ' 'VEkTItATIONFAN <br /> 6 DISHWASHER �.� �,� .�i�� ' RANGE HOOD � <br /> ' WATER HEATER � <br /> LAUNORYTRAY ' ' <br /> CLOTHES WASHER ' <br /> ' D TOVE ' <br /> TAL,f�IREPLACE(WOOD RNING) ' <br /> URf�AL : ��:;.',t ,� �,,�;,:i . . �: u��� i � � <br /> DRINKING FOUNTAIN FIREPLACE INSERT �— <br /> FLOOR DRAIN ' HEAT PUMP <br /> BACKFLOWPREVE ERS .,I , . ASPIPING ;— <br /> ROOF DRAIN AINLEADERS "� � FiA $T FA --:— <br /> � <br /> SINK(SERVI —BAR,ETC.) ; <br /> � <br /> —r— <br /> SUBTOTAL S ' SUBTOTAL 5 _ <br /> PEFMIT S <br /> PERMIT 5 ' �O7�L FEE S <br /> TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: FEE ;eceiar no <br /> REAR SETBACN SI�E SETOACK PLAN C GN NUMBER <br /> FBONTSETBACK j� L� <br /> USE ZONE LOT AREA <br /> VACANTS�TE FEES VALUATION FEE <br /> '-i YES � N� BUILDING <br /> i <br /> iVPEOfCONSi. NOOFSTORIES ttN�autr uOqOxEu��Gubi15 i <br /> c4W' PLUMBING ' <br /> SREOFBIDG. FIRESPRINKLEFSREO'U BASEMENT MECHANICAL _ <br /> G YES �.:, NO <br /> OCCUPANCV IOnD FlRE ALARAI REO'� HEIGNT Uh11iAT10N <br /> AODITIONAL PLAN CHECK <br /> OTNER _� <br /> REASON STATE�UILDING SURCHARGE <br /> INTANE BV PLANS APPROVED BY CITY OF EVEREIT PUBLIC WORHS _�_ ' <br /> LOCALSALES <br /> o�re TAX CODE IS 3105 TOTAL <br />