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APPLICATI('"`! FOR CONSTRUCT" �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYS � r� L• ' GAS J ELECTRIC ❑_ —� <br />259-8810 <br />! DEMOUTION Il COMBINATION I BUIL[tING jjA(ECHANICAL �UMBING SIGN <br />O\YNER A /� MAILAD�RESS p�TYfJ, 21P PIIOVE <br />TE��F'T"1 \ b��LAD�S � I I��/—��CI I.l� Il I�ZIP���bf t �.. ��'� � <br />CI'Y � ZIP <br />CITY ZIP <br />cir� <br />�ESGRI@E WORK AND <br />PROPOSED IISE OF <br />�can� utbGNloiION OF PqOPERTV iSNOWN BELOW OR 4TiACH T WO COPIES� <br />LOi BLOCN OF <br />PARCEL TA%I D NUAIBER / (�J/ �/7' <br />CONSTRUCTIONLOANLEN .AER DDFESS, <br />PROJECT ADDRESS . <br />TYPE OF <br />WATER CLOSET <br />N <br />KITCHEN SINK 8 DL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAI. <br />DqINKING FOUNTAI <br />ROOF <br />SINK ( <br />ITEM <br />PNOh; <br />� � _ <br />M <br />LONTALT PEli50N AND PNONB NO - <br />4�,�:aGF Ar'�t1�,v 3Lz� /9 <br />i HEREBY CERTIFY THAT 1 HAVE READ AND I=XAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW R� NG CONS RUCTION OR THE <br />PERFOPAIANCE CO ION. T T I A HORIZED BY THE <br />OWNE OPE O PER R H WORK FOR WHICH <br />APP CAT S MA E AND I P WITH THE 3TATE <br />C TR LAW 1,27 CW AN 2. AC <br />NO. <br />OF <br />FORCED AIC7 �YSTEMS-8. <br />UNITHEATrRS—B.T.U. M <br />CLOTHES �R1'ERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE �WOOD <br />FIREPLACE WSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUST FAN <br />SUB TOTAL 3 <br />PERAIIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />PRONTSETBAGK REARSETHFCK SIpESFlBACK PLANCfI- KNIIM�ER f[C <br />� � �� �� <br />❑5[ZONE �OTARE4 VAL/Ni51TE FEES <br />� � YES "� NO BUi�oiNG <br />TYPEOFCON57 NO.OFSTORIES ptc.�or.vcr �,�O=ewEwrvr,urrts <br />eaoun <br />PLUMBING <br />SREOFBLUG FlqESPqINKLER5RE00 BASEMENT M[CHANICAL <br />YES NO <br />OCCUPANCYLOAD FiaEa�naMaeoo HEicFrcurni;nrioN ADOI710NALPLANCHECK <br />9[ASON OTHER <br />STATE BUILDING SURCHARG[ <br />INTAKE �Y PLANS APPROVED OV CITY OF EVEREIT pU�LIC WORH$ <br />LOCAL SALES <br />o�Te TAX CODE IS 3105 TOTAL <br />FEE <br />M E.A. <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ ---? <br />X <br />� <br />r" _ <br />0 <br />