Laserfiche WebLink
- APPLICATI�N FOR CONSTRUCT'�ON PERMIT � <br /> TO BE COMPLETED IN BLA�K INK-PLEASE PRINT �;•/�•,,•�.rr <br /> �{LAN Co � i . �' <br /> BUILDING DEPARTMENT , � HEATING SYSTEM:. GAS ❑ELECTRIC ,0 <br /> 259-8810 <br /> Cl DEMOLITION 17 COMBINATION D(( BUILDING I I MECHANICAL f'I PLUMBING 17 SIGN <br /> OWNE�AR�� IA��ppESb CITV ZIP PHONE <br /> f� ID <br /> ��T MAILAODflESS CITY . ZIP PHONE <br /> MCHITECTOH�E910NEfl MIIILADDqESS CfiV 21P p�qryE <br /> OENERAL CONTMCTOq W1LL ADDpE63 GITY ZIP PiqNE STAT!LICENSE/ <br /> L � L $(1/LDc�S l071� FII�RL�� ���kt� EV�ETT W BZo� 7qa ISrI Sl L23U11�'lERI P$ <br /> MECHANICALCONTMCTOR WVLADDqE6S CITY =IP PIIONE 8TATELICENSEI <br /> ����T�T� ���� CITV 21P PHONE STATELICEN6E/� <br /> L1A880F WOAK �. <br /> . NEW ❑ ADDITION 17 ALTERATION I I REPAIR I-I DEMOLITION , I I WOODSTOVE/FRPL INSERT f_I BUILDING HELOCATION I <br /> , <br /> � CONTACT PEflSON AND PlIONE NO. � I <br /> CONfMCT PHICE OF WOqK � � O N D � . <br /> � ' '� OE�BCNIBEN'aRKl1ND90UAflEFOOTAGEINVOWED . <br /> Z9o - IQ � B <br /> � � P�E����� � I HEflEBY CERTIFY 7HAT I HAVE READ AND E%AMINED THIS <br /> ' � � ' � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL ' <br /> ! i <br /> . LEdLL DEfiCNIP710NOf PROPEHiV(&qWN BELOW OqATTACH FWfl CAPIES) PFOVISIONS OF.LAWS AND ORDINANCES OOVERNINO THIS TYPE OF � .� <br /> � �or�_ ewcu __ oF _ WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR I <br /> - � NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO GIVE i <br /> E I 5�N N o l,c� Il I .rj I OTHER ST E OFi LOCAL LAW REOULATIN�CONSTHUCTION OR THE I <br /> �' � ' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> � � OWNER OF THIS PROPERTV TO PERFQRM 7HE WORK FOR WHICH , <br /> _ j APPLICATION IS MADE D I C PLY WITH THE STATE � <br /> � ' � � CONTRACTO W;827 AN 6. 0 WAC. � <br /> � � �� b ; <br /> , - , <br /> : ioihL 9 S ' ` , <br /> O wre <br /> P�T+�S� �RAC�� 44 8 <br /> . . � CrtYMIlNEBSL N0. . • . . <br /> : � 2 rPLUMBINO MECNANI L <br /> . � NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE � <br /> � WATER CL0.SET(TOILEn � A/C—AIHNOLG UNITS—H.P. , �� <br /> i —�— <br /> � 9A1'HTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS--B.T.U. M ' <br /> � <br /> � : SHOWER � CLOTHES DRYERS � <br /> � KITCHEN SINK 8 DISP� ; VF.NTILATION FAN � �' <br /> / DISHWASHER � RANOE HOOD � <br /> UIUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � ; <br /> UHINAL � METAL FIREPUICE 6 CHIMNEY � — <br /> DRINKING FOUNTAIN , FIREPUICE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � � <br /> 6ACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � � <br /> � SINK(SERVICE—BAR,ETC.) ; � <br /> , <br /> 1 V � <br /> ' 1 ^ <br /> 1 i . . 1 <br /> I 1 <br /> I 1. <br /> SUB TOTAL $ ; SUB TOTAL S �'r <br /> - PERMIT S � ' PERMIT S � <br /> � TUTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: S G ZOD <br /> � FRONT��CK PEMz CK � SID��ACN� L PLANCHEGKNUMB H FEE O — RECEIPTNO. <br /> ! .�� <br /> � 27 ..� <br /> � usEzone �oT�n� v�cuarsire FEES VALUATION FEE <br /> Q �S I I �I� BUILOINO �� . O� � i� <br /> TYPEOFCONi9.ALLOWABLF TYPEOFfANST.ACTUAL oxw'wcr xo.qowEWxouxns . i <br /> � � aP / PLUMBING � ' i <br /> SI�EOFBLD(is,f� NO.OFB70RIES BASEMEN7 MECHANICAL i <br /> � s G.0 Z N" � <br /> . OCCUPANCYLWD FIRESPRNKLEfl5fiE0'D MEIGHTLIMITATION ADDITIONALPLANCHECK 2 i <br /> NO SoRINKIFR � . <br /> REASON 3PflWKLER9 <br /> STATE BUILD�NG SURCHAROE i <br /> INTAI(EBV PUNSAPPROVEDBY CITYOFEVEREiT PUBLICWGRNS w � �— <br /> �Jf'�' LOCAL SALES � <br /> y� 43 1'AX CODE IS 3105 T�TA� �9 ;L� <br />