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APPLICATIC��7 FOR CONSTRUC�a JN PERMIT (;� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> HEATING SYSTEM: U GAS ❑ELECTRIC J _� ��i�- �- _—� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATIQN BUILDING MECHANICAL PLUMBING SIGN <br /> - OWNER MAILADD�E<S CITY 21P PIIONF • <br /> �` � S <br /> ��i .,ii � ?b: lt' h�P i��. (�;�/"r� c.A �C '� . (� _ �� c l <br /> c,;i,r�rr�; �;, �;n,�., ,�l -. � <br /> T[NANt <br /> �ea�nooaess cnv z�P ar.or+e <br /> Al1C��rt[CTOiiDE51GNER �•�AIIADOFESS .{ CITV p /- 21P p 9 PMONE <br /> �'�-�'IIVT CI�iIC/�7 BC�X-} ���?ll iC� /3C��T S `)I/�l R(� ��0� J3 ��� �`�' .' <br /> GCN[RFLCOYLRRCTOR 6�ARADDRE55 CITV Z�P PMONE STA1E'ICENSE� <br /> �ct�� r?Li'�tiF Ci >>��i> > TiU?(;S �1 <br /> 2l ,( • LX 'V�l S' �t/)7y(i= �%S133 ;�C257'-'S` ,a�izi/VC� 1',i.i i; <br /> MEGMANiGALCONiRACTOR AiRiLRDURESS CRY ZIP PHONE STPI[UCSNSE• <br /> � <br /> �Q�� CIiY 21P ���ONE SiRTE LICENS[e <br /> PLUA191NG CONTRAGTOR M�R�D�RE55 <br /> aym =- <br /> H .� CLASSOF\YOAN <br /> y ~ NEW x ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE�FRPL INSERT BUIL�ING RELOCATION <br /> � y� CONiAGiPEy�yAN�PHONENO <br /> � y,o,� , �, f//,�in.e_ 3�a -�vci� <br /> COMRnCT PRiC[OF WORN �I�J��L' T <br /> D[SCRI�E\VORH AND SOUARE PO01/•GE INVOLVED � <br /> � xp .��-i��;,r�,���v i�•n� f'r 5�/FD ��[i^r 19�� <br /> H�'U F�noroseouseoFeuaowc i HEREDV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � ~ �'f.1/� /�(�/i) �HF P APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ��� iecniocscaiPno OFPROPERTVISHOYMB[LOWORATi4CMFOURCOPIES� yypRK WILL BE COMPLE7ED WITH WHETHER SPECIfIED HFf,eIN OR <br /> x H 3 �oT ��`� e�ocK CC'C� oF ����L l C�/ l/rl(,� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> � y z AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHP^S�ATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> H H pERFORM�NCE OF CONSTRUCTION.THA7 I AM AUTHORIZED B':THE <br /> g � OWNEF OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> H <br /> f] �y(A APPLICATION IS IdADE AND I COPAPLY WITH THE STATE <br /> � �'r �� CONTRACTORS LAW 1827 FCW AND 296200 WAC. <br /> � � : <br /> H O[yi� x / '.`,/ ��� < <I/�a l�- <br /> �� <br /> ....141i'.qi 9 ::A!! <br /> aPJJEGT�DDRE55 � '^���'���� - <br /> ,<rll f'��Fi_��fr�� tin_ r�r ,�'FT7 ��,—��,z�:•:,�<F�«„o <br /> PIUMBING MECHAN�CAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT <br /> FEE <br /> WATER CLOSET�TOILET) _ A-0—A HNDLG UNITS—HP. <br /> f�� BATHTUB — FGRCED AIR SYSTEMS—B.T.U. M E.A. , <br /> �� LAVATORY�WASfIBASIN) UNITHEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> � RANGEHOOD <br /> � —' DISHWASHEP� — yyqTER HEATEF <br /> LAUNDRVTRAY — <br /> CLOTHES WASHER WOO^STOVE . <br /> METAL FIREPLACE 8 CHIMNEY <br /> '.� � URINAL FIREPLACE INSERT <br /> ..�� ORINKING FOUNTAIN <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> �'"' ROOF DRAINS--RAINLEADERS ExHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) _ <br /> � ! —r— <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> — PERMIT S <br /> f�'`' TOTAL1 FEE 5 TOTAL F[E 5 <br /> FOR OFFICE USE ONLY: AeceiPt r+o <br /> . �� raor+rscrencK nenAseToncK / Si�E5ET6ALN / rinNCNECKay�.�o� �� Fe�I �J �`-,7�9 -�� I <br /> / s �_> J C. iB <br /> VALUATION FEE , <br /> USE ZOfIE LOT ARGp VACANi SITE FEES �i <br /> PUILDING ''35V �J ���0 ' <br /> iYPEOVCONIS<ILOW�BLE iYPEOlCONSfRG1UAl oc[��'+:[• nc�,x;rnLv'.:.u:��s i <br /> �°^�v pWh7�ING ' <br /> _�1 �" "' —,-- , <br /> SIZEOF9LDG. NOOFSTORIES BASEhI[Nt MECHANICAL I <br /> 4o sF � I <br /> dDDITIONAL PLAN CHECK <br /> OCCUPNNLVLOAD RR[SPRNNLERSPEOD MEIGIIT7IIMIIAIIJt� i <br /> ��Q_ N/A (/ SPRINKLER _ _ �_ �, <br /> nEasoNFoasPr�rvrcLFuc I� � SO <br /> STAiE�UILDING SURCNARGE �, <br /> rt�iANEBY r�nr�saraHoveonr CITYOFEVEREIT PUBLICWORK$ _ �I <br /> LOCAL SALES <br /> �I�� �v�,g �z TAR CODE IS 3705 TOTAL <br /> i <br />