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APPLICATIC�I FOR CONSTRUCT. )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS ❑ELECTRIC I] <br /> BUILDING DEPARTINENT <br /> 259-8810 /` <br /> I ' DEMOUTION I I COMBINATION f i BUILDING ;i'MECHANICAL i I PLUMBING LI SIGN <br /> OWNEF � MNLADORESS ,�� CITv, / ZIP PNO�!!' ,/ <br /> �� a n� /o[ E ��..��-� /1f����t� � �i��c_,.� 7�'�a/ ���- �`�-�- - <br /> Fy�ry�y/ A7MLAD�FESS IP PHONE <br /> �a� a�� 3��-� ��,c��� ��.�� G�,.��, ��o/ �5��- Sll6.� <br /> ARCNITGQ OR DE513NER ��A�L�DOPE55 CITY ZIP PNONE <br /> GENE��T�A�`„�'M � CITV ZIP�� �7 �LY�NE /i'//�Sl1J///7�/�U\ 1-- <br /> �� � CIiY ZIP PHONE STATELICENSE� <br /> MECH U f���'���� <br /> w� sa s� <br /> PLUMBING WNTRACTOR tdAll ADDRESS CITY ZIP PNOHE STATE LICENSE t <br /> CONTFACT PRICE CF WOjJf/. � y <br /> r <br /> tY� (� <br /> UtSCRIBE\ViRK AND SOUARE FOOTAGE INVOLVED � ('l�� CONTACT PERSO^ ND PHON[ � �� f� �C��//nr� '//� <br /> � � ) Y� <br /> �/.� C� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSE(iF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF • <br /> LEGhLDESCFIPiIONOFPROPERNISHOWNBELOWORATTACM'WOCOPIES� NOT. THELGRA T�NG OF AD ERMIT DOES NOT PRfESUME TO GNE <br /> ior e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> -- PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEFTY TO FORM THE WORK FOF WHICH <br /> APPLICATION IS M COM ITH THE STATE <br /> PnRCEI TA%ID.NU6IBER . � � — _ � � _� CONTRAC'.ORS 18. N .200 W . <br /> � ) / / <br /> CONSTRUCTION LOAN LENDER.RDDRESS.TELEPHONE NUAIBER / �+ 1„ � <br /> ( � �" ( <br /> � smvaiune o"iE <br /> PROJECT ADDRESS � � � <br /> � eirv ous�Ness ucE�sc no <br /> PLUMBING y MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM PEE N0. TYPE OF EOUIPMENT FEE <br /> • WATER CLOSET(TOILET) � A�C—A�HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN� UNIT HEATERS—B.T.U. PA � <br /> � CLOTHES DRYERS ' <br /> SHOWER � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER � RANGE HOOD _ <br /> LAUNDRYTRAY ; WATERHEATER ._ <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL � � <br /> DRINKING FOUNTAIN fiMEPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADEFiS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> � <br /> SUBTOTAL S SUBTOTAL $ �J ' <br /> PERMIT S PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE S " <br /> FOR OFFICE USE ONLY: aeceiar No <br /> FRONT SETBACK REAR SETBALK SIDE SETBACK PLAN CHECK NUMBER FEE <br /> USEZONE LOTAREA VACANTSITE F ES VALUATION FEE <br /> G YES � NO BUILOING ' <br /> iVPEOfCON51. NO.OFSTORIES Ottuv�htt u00�eK[u�4fiu.�i5 � <br /> cAouv � <br /> PLUMAING <br /> 512E OF BLDQ FIRE SPRINNLERS REO'D BASEMENT MECHANICAL � <br /> - YES NO <br /> ADDI710NAL PLAN CHECK ' <br /> UCCUPANCYLOAD FIREALAFMREO�O HEIGHTLI�IITATION � <br /> OTHER � <br /> RLASON <br /> S1ATE BUILDING SURCHARGE <br /> INTANEEY PLANSAPPROVEDBY CITYOFEVERE7T PU�LI(.WORNS � <br /> LOCAL SALES <br /> oATE TAX CODE IS 3105 TOTAL <br />