Laserfiche WebLink
. . APPLICATr"'�N FOR CONSTRUC"J10N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> s� : CRq1G�E �;��ry �-a11 <br /> HEATING SYSTEM: �GAS O ELECTRIC ❑ __J <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i DEMOUTION � COMBINATION I I BUILDING I I MECHANICAL i i PLUMBING i i SIGN <br /> -- — _ _ -- ---- <br /> UWN�II ---_- �_���L�UUHL55 CITY ZIP YI�ONk <br /> �EI-tcl l�nif� IIJC �37 EI-1'Vl 'f� EUEkE'TT ��S"1 i 'S�� �SC' � — <br /> ICNANI MML/�WRESS CITY 21P P110NC <br /> nNCHiIFCTOf1UE51GNfN M�0.ADDNESS Gi7V ZiP PIIOME <br /> GENE�.ALCON7RAClOfl AU0.A�OflESS CIIY ZW PMONE SG1ElICLNSE� <br /> ;N_rnE �ts n�t�nF1� :�L�i i{ 1 116�r�ti <br /> IACCh�NILALLON7MC10R 1MM.MIXiESS CITY IIP P�qNE 5iA1El1CLN5[i <br /> PIUMBINGCONTflACTOfi M�I�DPE55 CITY Z�P PMO�E SUItLiCLNSL• <br /> (;ONTRAGi PflICE OF WOflK <br /> q n �ao <br /> �ESGRIBE M/OfiN NI�SOUARE FOO7�GE INVOLVED �LT PERSON AND P110NE NO. <br /> 7.S'—ISG�f — <br /> —� <br /> s Fe ---- <br /> I HEREBV CERTIFV THAT I HAVE READ AND El(AMINf:D TMIS <br /> �•norosw use or uuwoi�+c APPLICATION AND KNOW TME SAME TO BE TRUE AND COHRECT. ALL <br /> <"�F�' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �EGNLDESCRIPTqNOFPHOPEHTYI������RAT7�CM7WOLOPIES) WOFIK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GiVE <br /> i.ot� et.mK aF A AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> R It � t7 LUI SIO N `T _ OTHER STATE OH LOCAL�.AW REGULATING CONSTRUCTION OH 1ME <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CIi <br /> APPLICA?ION IS MADE AND I COMPLY WITH THE SipTE <br /> 1'AflCEL7A%IO.NUMeeR CONT C S W .27FiCWANDz96.200WAC. <br /> CONSTRUCTION IO�N lENOEfl.ADDRESS.IELEP110NE NUMBER �� <br /> �_ �.-�s3--- <br /> PHOJECT ADDRESS f °�" <br /> '� -- <br /> S�zV sr r ��,..���,�E,�,� <br /> PLUMBING MECMAIWCAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEH CLOSET(TOILET) � A/�NMNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. �_ <br /> LAVATORY(WASH BASIN� � � UNIT HEATER�B.T.U. M _ <br /> SHOWER � CLOTMES DRVERS <br /> KITCHEN SINK 6 DISP ; �G VENTILATION FAN ' <br /> DISHWASHER � I RANGEHOOD � __ <br /> LAUNDRYTRAY � WATER HEATER _�_ _ <br /> CLOTNGS WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BUfiNING� <br /> DRINKING FOU�iTAIN i FIREPLACE INSERT _�— <br /> _�_ <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVEN1EFi5 ; GAS PIPING <br /> ROOF DRAINS--RAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; �_ <br /> — � — <br /> — � --- <br /> � <br /> SUBTOTAL S 7_�i SUBTOTAL S G'�) ; <br /> PERMIT S PERMIT S <br /> TOTALFEE E ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> IfiON75ETtlACN RENiSE10AClt SIDESET@�CN PIANGNEGNNUMBER / fEE NEG IViNO <br /> 1 1 � �/-%�� 3� � <br /> u zo,�/ � iorenee v�c�'s rte FEES VALUATION FEE <br /> .�`V Z1O I�'(YES ❑ NO euiLDiNG /� �/� <br /> �vrlacoxs� raorslaliEs �Mcwvicr �aaornurcWn l��f�$S- ----- .` .� -_ . <br /> _TT' �___ __._ _—.2 - PLUMBING ____ ��'.-- <br /> �_ <br /> sB[ tlIOG fIRESPflINKlEN5NEOD �ASEMENT MECMMlIC�L <br /> IS�L SE+n nl� rl res �o -�— <br /> OGGUVN1CrlOeo FlR[M�RMREO'0 IIEIGMTLu1rtAT10N ADDITION�LPLANCMECK <br /> IJ/a o ' _—_JD �. <br /> OTMER <br /> ���.�« ----- � ; G <br /> STATE BUILDING SURCHIIRGE <br /> OIIANEBY PUNSAYpIiOVE00Y CITYOFEVEflE1T pusuCwoRKs <br /> �J I� LOCALSIILES 2U;— <br /> o�re Qj �(� TA1(CODE IS 3105 TOTAL Z� ;�� <br />