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APPLICATIO` FOR CONSTRUCT�N PERMIT � <br /> TO 8E COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILD�NG DEPARTMENT HEATING SVSTEM: AS ❑ELECTRIC ❑ <br /> 259-8810 <br /> Ll DEMOLITION �COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIQN <br /> OWNEF WlMDRF55 CIiY 2i> pHJNE <br /> /a��11� Ti�OtAClL //o� E /1iMt/uE.✓2�/ d2 O.�lS�T4�to, t�s—�-�ril?� <br /> r�_hwr r.ut�ow�c s cnv no wqr1c <br /> s�^-�- T,��� <br /> ARCNRECTOilOFSN'iNEP 4ALMORF55 UtY ZIP FIICNE <br /> GFN_EPC�Cp1iP�Clpfl NALADW1E55 LIfY 'IP p1q11C Si�iElCENSE� <br /> Ne2�So�INA ,lv/vOc,tiJ l�ayt� rr6Wr,�,pA.�yOn.cc. Jo/la�'J/36X�f <br /> MccNruwucorvrnncroa u�awoacss cnr zi° �1Gs CS3��/LJ s*ucicExs[. <br /> ttUMBMOGONlP�[i0fl M.10.AppPC55 CIiV SIP P1qNF. SiAiEIICEN$EI <br /> LCNiNACi PPILE Oi V�V11N <br /> OESGNIBEW011KANOSW�NEiW1AGEINVIXVED CONLIL N P ENO �(Q" <br /> z/� IraR�r Aoai;ia,J ar.o raMrN- <br /> �,J �ut,Mc� ep �ttil # <br /> I HEHEBY CEFlTIFY THAT I HAVE READ AND E%AMINED TNIS <br /> vnoroseo use or eunmuo APPLICATION AND KNOW tHE SAME 70 BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNIN�THIS TVPE OF <br /> iecacesc *rouorvraPennis e[�awonenecH 2s� WORK WILL BE COMP�ETED WITH WHETHER SPECIFIEO HEREIN OR <br /> �� /�'�� J O NOi. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tm aioce or i AUTMORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTM6;STATE OR LOCAL UW REGUUTING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM�UTNORIZED BV THE <br /> OWNER OF THIS PROPEFTV TO PERFORM THE WORK FOF WHICH <br /> vnncc�u�ioHu APPLICATION IS MAOE AND I COMPLV WITH TME STATE <br /> � �,/ ���� CONTR ORS UW 1827 RLW ANO Y%200 WAC. <br /> 7" L <br /> LpY51N11LT LOANLfNDEN.IiDDflE55SElEF11CNENUINBFR '/q p <br /> N ' <br /> VNQIECT�DDPESS /�� �w ��J—! 7 <br /> � '� ti0 � //�L� Ci1�M5M55lKtR4Ml <br /> PLUMBIN6 MECH�NICAL <br /> N0. TYPE OF Fl%TUHE OR ITEM FEE NO. TVPE OF EOUIPMENf FEE <br /> WATER CLOSET�TOILET� 0.�C--A�HNDLG UNIT�H.P. <br /> BATHTUB FORCEDAIRSYSTEM�B.T.U. M E.A. <br /> LAVATORY�WASHBASIN) UNITMEATER$—B.T.U. M <br /> SHONER CLOTNESURYERS <br /> KITCNEN SINrC 8 DISP VENTILATI(�N FAN <br /> DISMWASMER RANGE MOOD <br /> LAUN�RV iRAv WATER HEATER <br /> CLOTHES WASMER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRIIIKING FOUNTAIN FIREPLACE INSERT <br /> F�OOR DRAIN HEAT PUMP <br /> BACKFLOW PFEVENTERS GAS PIPING <br /> ROOF DRAINS—R4INLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETC.� <br /> SUBTOTAL S $UBTOTAL S <br /> PERMIT E PEPMIT S <br /> TOTAIFEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: JSS��� <br /> IPONiSEiBAC NUfl5C10ACN SiCES[iBALR PIANCN[LNNU4PF11 FEE /1 REC[:ViNJ <br /> � �- � �'t� 0.� <br /> usEza�e ior�ne� ��cu�rs�rc FEES VALUATON FEE <br /> �-a, C YES ❑ NO BUaDmG <br /> imorcousi raors.onics rci,a.a. wonc+m�n:�.n C' .7/. O .�� � Coc� <br /> Z °"°" xuMeinc 3S; <br /> S�ZEO�&W i1nE5P.iwitl[NSREOU 6�3�E4y�* MECNANI��� <br /> 3'!b SF. r�es ❑ No � ' v <br /> OCcu��NcriMo �iqE/�nnun[0� HEiGNiiiu�'/.fgy ��DIiIONAIPlANC11ECN <br /> ��e OTIIER <br /> RE�SCN <br /> ST�TE BUiLDING SURGN�qGE ) <br /> INiA'�LV RANS�PPIqVEDBY CIiYOFEVEBETT PUOIICWORKS <br /> LOC�L SIILES �— <br /> o.re TI1X COOE IS J705 rou� 1 0 <br />