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APPLICATIQ ; FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � O�e� <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC U —� <br /> 259-8810 " �� <br /> I 1 DEMOLITION I I COMBINATION � i BUILDING I 1 MECHANICAL �rLUM81NG I ! SIGN <br /> �0 N M�R I10DRE55 CIiY � ZIP PIqNE <br /> SLG ��-z �G .�G /C-0�`_S�' � eirT� y�.�cg 337 —Y7JS— <br /> TENANT MAII�ODRESS CRV IIP VNONE <br /> ARLNITECTOPDESIONER M�II�ODRE55 CITV ZIP PMONE <br /> OENER�.CONTR�CTOR MM1110�HE55 CITY ZIP PIKKIE STAiELiGlNSE� <br /> MECH�NIC�LCONTN� R M�R�Dd1E55 CITV 21P FHONE ST�TEIICENSE� <br /> ,Je / . <br /> PIUMBINO CONTRACTOR M�IL ADDRE65 CITY IIP PNONE STATE IICENSE t <br /> CONTR�CT PR1LE Of WOillt <br /> DE:�CRIBE WORIt�ND SW�RE F00710E INVOLVED CONT�Ci P'�PSq��ND PIIONE NO <br /> I HEFEBV CEFTIFV THAT I HAVE REAO AND EXAMINED THiS <br /> PipPOtlEO U5E OF BWLDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � G. PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �. . <br /> � a��nescnivrior� PROPERTY�SIICNNBEIOWOFARACNTWCCOVlES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br /> NOT. THE GRANTING OF A PERMIT DOES NnT PRESUME TO GIVE <br /> �ot e�ocK oc AUTHOfiITV TO VIOL<.TE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT i AM AUTHORIZED BV THE <br /> OWNER OF THIS PFOPERTV TO PERFORM T4E WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARL'EL TAx 10,NUMBER CONTRA/C�TORS LA�V 18.27 PCW AND 296200 WAC. <br /> CONSiPOLTqN LOI1N LENDEH.I100RES3.TEIEPHONE NUMBER ' " � �- <br /> uc � <br /> PROJECT ADDRE�SS// � //� - �`1 siee.m e � �'�L' ou� <br /> ��/041��f�ll V� SF O�vPuiM�S51�1:IM51�x1 � <br /> PLUM91N0 MECMANICAL <br /> N0. TVPE OF FIXTUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SVST�MS—B.T.U. M E.A. <br /> LAVATOHV(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHESORVERS <br /> KITCHEN SINK 8 OISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> ;AUNDRV TRAY ; WATER HEATER <br /> CL(��HES WASHEF WOOD STOVE <br /> UfiIN/�I METAL FIREPLACE(WOOD BURNINO� <br />� DRINY,ING FOUNTAIN FIPEPLACE INSERT <br /> FL(`JR DRAIN HEAT PIIMP <br /> BA�;KFLOW PREVENTERS ; OAS PIPING ; <br /> RCOF DRAINS--RAINLEADERS � EXHAUST FAN <br /> o�NK(SERVICE—BAR,ETC.) ; __ <br /> � — � <br /> SUB TOTAL S SUB TO7AL S <br /> PERMIT S PERMIT E <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONiSETB�GN RE�PSEtB�CN SiDF.SET9�f.N PI�NCIIECNNUMBER fEF �ECEiPINO <br /> USE TONE LOT ARE� V�C�NT SI1E FEES VALUATION FEE <br /> "� VES .l NO BUILDING <br /> IYVF Of CONSf ��F STORIER axun�N[r M m Owlwno ut�n — '— <br /> 4Bpj0 PLUMBING — <br /> SIIE OF BILG FIPE SPRINRLFRS HEdD B�SEMENT MECHANICAL ' <br /> '" VES f 7 HO �— <br /> OCWP�NCYLOAD fIRE�L�RMREOD NEIOHiLIM17�T10N ADDITIONALPUNf,HECK <br /> _ OTHER <br /> RE�SON - �— <br /> STATE BUILOING SURCHAROE i <br /> INTANEBY i'UNS�PPROVEDBY CITYOFEYEREIT PUBI.ICWORKS <br /> LOCAL SALES <br /> o�re iAX CODE IS 3105 rer�� <br />