Laserfiche WebLink
r•, r'�, <br />AP�LICATI�.nI FOR CONSTRUC7.dN PERMIT ���� <br />TO BE CCMPLETED IN BLACK INK—PLEASE PRINT <br />NEATING SYSTEM: ❑ GF,S '� ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING I SIGN <br />OWNER zQ e�. IAAILADDRESS CIN ZIP FNONE <br />�r� �n/� e. �7�/ � % � S �' �1.: .• / f'L j!�`�C-�- 1 v3 i '/ � � // 3 <br />1ENFNT MAILADDFE55 CITV ZIP PHONE <br />ORDESIONER M41LA�ORE55 <br />CITY ZIP PHONE <br />GENEFALCONTRqCTOR MFILAD�RESS QTY ZIP PHONE STATELIGENSEe <br />�o( f,= !'�k �cr�� �ri�ii iPz�� �s v- �S:s =i7f;rccczza�r; <br />MECHANILALCONTRACTOP MAILAODRESS GTY ZIP PHONE STATELICENSEtl <br />PLUMifINGC04TR<GTCR MAILAD�RESS CITV ZIP PMONE <br />ClA55OF WORN <br />'. I NEW . ADDITION . ALTERATION �REPAIR . DEMOLITION WOODSTOVFJFRPLINSERT <br />� � CONTACT PERSON AND PHONE NO. <br />CONTHACTPflICEOFWOPK ' /COG <br />DESCRWF WORK AND SOU�RE FOOTAGE <br />/�c�.��a �-w� u <br />PROPOSED USE OF BUILDING <br />LEWlOESCRIPTION OF PROPERTY (SHOWN �ELOW OR <br />LOT BLOCN _ _ Gf _ <br />PRQIECTADDRESS �` / <br />I�i� � 9 � S� <br />PLUMBING <br />NO. 'lVPE OF FIXTURE O <br />WATER CLOSET (TOILET) <br />BATHTUB <br />CAVATORY�WASH BASIN) <br />SHUWER <br />KITCHEN SINK 8 D!SP <br />C7iSHWASHER <br />l.4UVDRY TRAY <br />URINPI. _ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FFONT iET�4CX REAR SETBAC� <br />� �� <br />USEZONE <br />AqEA <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALF'cE 5 <br />T <br />IYPEOFCONiS.ALLOWABLE IYPEOFCOqSi.ACIDAL <br />'/r 'A/ <br />SIZE OF BLDG. NO.OF STORIES <br />��I 1�� 2 <br />OCCUPANCV LOAD F�RE SPRNNLERS REO'D <br />u a i�� <br />REASON FOR $PPINNLERS <br />FEE <br />STnTE LICENS[ x <br />BUILDING RELOCATION <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />A.PPLICATION AND KNOW THE SAME TO GC 7RUE AND COHREC2 ALL <br />PROVISIONS OF I.AWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE CCMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANI'ING UF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOR i LAW 1827 FiCW AND 296200 WAC. <br />x [y . �� �io ...-• _ /- /G- 7j <br />siarvnroae onre <br />NO. TYPE OF E�UIPMENT FEE <br />P�C—P�HNDLG UNITS—H.P. � <br />FOHCED AIR SYSTEMS—B.T.U. M E,A. ; <br />UNIT HEATERS-9.T.U. M � <br />CLOTHES ORYf_RS � <br />VENTILATION FAN � <br />� RANGEHOOD <br />; WATER HEATEFl _ <br />r WOOD STOVE <br />; METAL FIREPLACE 8 CHIMNEY <br />� FIREPLACE INSf_RT <br />� HEAT PUMP <br />; GAS PIFING <br />� I EXHAUSTFAN <br />NU OIpWELL)NGUN115 <br />l <br />BASEMENT <br />� �7 <br />HEIGN71^IMIT�ION <br />INTABEBY PLANSAPPROVEDBY CITYOFEVEREIT <br />J� I/Z,/qt �OCALSALES <br />TAX CODE IS 3105 <br />SUB TOTAL 5 <br />PE(iMiT 5 <br />TOTAL FEE S <br />o. � <br />PL�NCHECKNUMBER�� F� /���. RECEIPTNO. / <br />.� J 3 . r 5��3`% <br />BUILDING <br />PLUMBING <br />�dECHANICAL <br />A�DITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHHRGE <br />PUALICWORKS N�.r/'—fG <br />TO7qL <br />