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lltr [(rrr,?i'i'it ' /i/ �V�� u C ■ �� �' <br /> � v �i ��� P E R iVl IT PERPAIT N0. � � > `` !- <br /> CITY HALL 259�8745 <br /> eveaerr, wn sezo� C COMBINA710N ❑ BUILDING �XX MECHANICAL ❑ PLUMBING <br /> OVJNER MAIL A�DRE55 Cliv ZiP pnCl�[ <br /> Ron Spelhaug 3116 113t:. Place S.W. FVPyp+-r 98204 353-0356 <br /> ARCHRECi OR OESIGNEF MAIL AODPESS GiY ZIP PHONE <br /> GF�lERAL CONTRACiOR NAIL ADORE55 CITY ZIP pMONE LICENSE N <br /> 61ECHANICAL CONTfiACTOR MAIL AD�RESS CITY ZIP PHONE LICENSE x <br /> Same <br /> PWIdBINGCONTRACTOP IAAlLA00FlE55 CITY ZIP pHONE LICENSEs <br /> GLASS OF WORK <br /> ❑NEW ❑ ADDITION ❑ ALTERATION ❑RC-PAIR ❑ OEMOLITION ❑ FENCE ❑ SIGN �WOOD STOVFJFIREPLACE INSERT <br /> VFWATION OF WORK <br /> S <br /> �ESCRIBE WORK <br /> install o clearance fireplace <br /> anoroseo use oF euamric -- z <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> APPLICATION AND KNOW TH[ SAME TO BE TRUE AND "' <br /> LEGAL DESCRIPiION OF PROPERTY�SHOW�ELOW c R qTTACH FOUP COPIES� �. n <br /> CORRECT. ALL PROVISIONo OF LAWS AND ORCINANCES �T <br /> �or_e�ocK oF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH �� <br /> WHETFiER SPECIFIED HEREIN OR NOT.THE GRANTING OF A ,.., �, <br /> PERMIT DOES NOT PRESUME TO GNE AUTHORITY TO VIOLATE -i T� <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR .-� --{ <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE `^ _ <br /> m <br /> PERFORMADteE Or CONSTI�UCTION. 5/16/85 � o <br /> JOGAL�RES` SIGIlAiUREO� �iR�CTOR /pTHORIZE�NT DFTE m0 <br /> 1040: lOth Drive S.E. X /���,�;, �� ��LC�*� � � <br /> o - <br /> PLUMBING MECHANICAL � Z <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE m� <br /> WFTERCLOSET�TOILE7) AIR COfJD. UNITS- H.P. EA. .O < <br /> BHTHTUB REFRIGERATION UNITS- H.P. EA. y -1 <br /> L4\'ATORY(WASH 9ASIN) BOILERS - H.P. EA. <br /> rr-. �-_. <br /> SHOWER GAS FIRED A.G UNRS - TONNAGE EA. -< N <br /> T <br /> KITCHEN SINK 8 DISP. FORCED AIF SYSTEM�- B.T.U. M EA. O x <br /> TI D <br /> �ISHWASHER WALL HEATERS- B.T.U. M <br /> --I f�i <br /> LAUNDRYTRqY UNIT HEATERS- B.T.U. M = <br /> - m �� <br /> CLOTHES WASHER EVAPORATIVE COOLERS v: <br /> — O <br /> WATER HEATER CLOTHES DIlYERS o r <br /> � m <br /> URINAL VENTILATION FAN C </` <br /> DRINKiNG FOUNTAIN RANGE HOO� m N <br /> Z r <br /> FLOOR DRAIN p�R HANDLING UNIT- QP.M. -1 r" <br /> . m <br /> VACUUM1I BREAKERS STOVE - WOOD Y <br /> -' A <br /> ROOF DRAINS- RAINIEADERS 1 METAL FIREPLACE& CHI�dNEY � <br /> SINK�SERVICE - BAR, E7G) FIREPLACE INSERT D' <br /> HEAT PUMP <br /> — _ <br /> — � <br /> z <br /> SUB TOTAL 5 SU9 TO7AL 5 � �Q_ C <br /> --1 <br /> PERMIT 5 PEPMI7 5 <br /> i. <br /> TOTAL FEE 5 TOfALFEE S 1� SO r <br /> SIOE YARD SETBACK STREET SETOACK REAR YAFD SETBACK PLAN CHECK IJUMBER PLFN CHECK FEE <br /> FEE RECEIPT NO. <br /> 115E ZONE LOT AREA VACANT SITE — -- <br /> YES .:NO FEES VALUATION FEE <br /> TVPE Of CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING 5 <br /> SIZE OF BLDG. NO.OF STORIES MA%.OCC. LOAD -- <br /> PLUM1IBING <br /> RIlE ZONE BASEMENT FIfiE SPRINKLEflS MECHANICAL <br /> REOUIRED 17 50 <br /> �. .YES : �.NO <br /> � APPROVALS BY DATE OTHER <br /> 1. ENVIRONMEN7AL CHECK LIST PENALTV �'8�' <br /> 2.BUILDING PLANS SEC.3U3(a� <br /> 9.FIREHVDRANT TOTAL ].� SO <br /> a.FIP�c PROT[CTION SYSTEM PEFMIT VALIDATION <br /> 5.GicADING WHEN PFlOPERLY VALIDFTED(IN THIS SpACE)THIS IS VOUR PERMIT � <br /> G.DRAIP:AGE ' � . . _ � <br /> 7.ENVIF:ONMENTALIMPACTSTATEMENT � <br /> J.HEALTH�I3TRICT �'r <br /> v-ti <br /> SPPLICdTION ACC. 8}' PLAIJS CHECKED BY APPR. FOR ISSUANCE BY - <br /> . _ .. ..__., f-;, <br />