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APPLICATICi FOR CONSTRUCT"`l�l PERMIT �✓� <br />TO B� COMPLETED IN BLACK INK—PLEASE PqINT <br />-- — _ _ - — <br />BUILDINGDfF'1F�MENT ( HEATII1�;SVS7EM: � GAS �.,�ELECTRIC J__ � j <br />`�--- -- _. , <br />259-8810 <br />DEMOLIT�ON _ COMBINATION �'-BUILGING MECHANICAL PLUMBING SIGN <br />owncR MN� npo'iess ---on.—_--- (ir w�nNE --- <br />?1 r�'.vt �3.�._ � a��t• `A��s�,�'t��'l�1��2 � -- ����sS'� <br />EN�NI M�R �DORE55 rp ; itv li�` vNOryl <br />/ ✓- 0-i� ��}�hs7 -�e n, t l� � ` � �' �� 4 — --- <br />�acwrecronoesiaN�n e�n�i.eno�iess ar. iu� r.�:mi -- <br />��L�,0.�d��1F7P�6�»f718-Js�_3�*�l�s��^�'/P�?y 1r��0�_�P��fy�Irdh_c_Mi�-�J /�/7 <br />ceN n.�cowin�crnn uan.ennnFss cirv rm r�mrrt tirnrr�icer+se. <br />14��$ �—.�_a�!_-l�L��iN� _-� 4 �1-.'� �.r ^is�.^ G l�'v_ A� o c A_�'�q� <br />MEGH�MCAICJNiq��i0� MniI�ODPE55 Ci�v IiP P��p�ih !iUiFIICFNSE• <br />��kn+���i ,�-/��/}?i�Nc �vs�tn_ilv���e 5'�e7y_»�i %�lili�LG/�J137A1� <br />PWMBMGCWiR�CTOP MRILRD PESS �:�T )il' vNOa[ Si�tEIiCFNSf• � <br />CUNTR�Gi PRiCE C' VA',RN <br />U� SfRi � WpqK �ND SOU� iE FOOT�OF INVOLVED <br />--1�t� �i o m � <br />PROPOSf.0 USE O� BWIUING <br />_ �ok,.` <br />tEGLL �ESCRIPTION Oi PqOPEPiY ISHOWN BELOW OR �tt�CN iWU COPiF51 <br />� a, �— a��K �� .E[_s_,�/Y��+�J_-�_ <br />GUu�pr <br />cf_'�` _o����ta�,�_���lr_-- - — <br />�r_� tS'i� 0/tlf7� /.,i�� '/1/� V� /Y. �tr'�4%_ —__ <br />PI RCI l 1�N � D 4UMAER s'�`=C• ,2 0 TW p, 3� -JV� IPG k S� <br />�:NISTRUCt10NLOANIENOFR�DpRE551ELEP��ONENUM9FR � <br />TYPE OF i�-.TUFE OR ITEti <br />WAT�R CL�lSET �TOILET; <br />BATHTUB <br />LAVATORV (WASH BASIN) _ __ <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />URINAL <br />DRINNING FOUNTP.IN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEAC <br />SINK 1SERVICE-BAR. ETC <br />FOR OFFICE USE ONLY: <br />INONiSFiPAf,N � R54q5FlHACk <br />G �) <br />use �zor�c� <br />-�=-' <br />IvvF Of CONSI <br />L�_ <br />Sjlsj�l `��jFt <br />�/ LS F G <br />IX;CUP�NCv lO�f� <br />�FRS�N /? <br />_�`_' <br />LOI�qtP <br />OL <br />V <br />SUB T0T,11 $ ; <br />PEfiM1T $ —T <br />TOTAL FFE $ <br />91DE SET9�f.N <br />V�C�N SITE <br />� - YES NO <br />n�.n�. � w� vnwtii����.a:. <br />FIRESP�iNMlER5f�E0❑ B115EMENt � �� <br />AI � � VES YNO <br />GONTACT PERSON �ND PINNlE NO <br />i NEHEBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICAiION AND KNOW THE SAME TO BE lRUE AND CORRECT. ALL <br />PROVISONS OF LAWS AND ORGINANCES COVERNWG THIS TYPE OF <br />WORK WILL BE COMPLETED VJITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERhAI I �OES :�OT PHESUME TO GIVF <br />AUTHORITY TO VIOLATE OR CANCEL THE PR01 �SIONS OF ANV <br />OTHER STATE OR IOCAL LAW qEGUI.ATING CONSTRI �CTION Oii THE <br />PEfiFORMANCE OF GONSTP'1CTION. THAT I AM AUiHPR17ED BV 7�{E <br />OWNEfi OF THIS PROPERTV TO F'ERFORM THF WORK FOR WHn�.i+ <br />APPLICATION IS MADE ANG I COMPLV WITH THE STAi( <br />CON C70RS I.AW 1827 qCW ANU 296.200 WAC <br />����-..� %�� � `5 � 9 � <br />n+�f <br />,���. ___-_ __.—'---_ <br />MECRANICAL <br />NO. TVPE OF EOUIPMENT FEE <br />A-C-A�HNI)LG Uk.fS�-H P <br />� FORCEU AIR SVSTEMS--P 1 U M EA. <br />UNITHEATERS-B.T.U. M <br />� CLOTHES DFlVERS �— � <br />VEN7ILATION FAN � <br />T RANGE HOOD <br />/ WATER HEATER - <br />W��D STOVE _��t <br />MEiAL FINEPLACE (WB9D 3URNING) <br />FIREPLACEINSEFT <br />HEA7 PUMP <br />GAS PIPMG <br />EXHALIST fAN --� <br />� - -- --- --- <br />- -- —� - <br />_ _ Si �d TOTAL_ $ _ <br />Pf_RMIT $ <br />- _—__- ___ ---.-`)TAl F:E $ � <br />rinr�� uF �r mnniern I rF <br />�3 70� <br />FEES <br />BUILDING _ -- — <br />PI UMFIMG <br />MECHFNICAI <br />MEi6HiuMtt�noN ADOITIONAIPIANCNECK <br />— ..� �_ � �,�E�� r L, <br />SiATF BUILDING SURCHqRGE <br />��n�Ke a� PUNS�PPROVtDBv CITY OF FVEREII <br />�J ki LOCAL SALE� <br />_ n.�r � j�- TAX COOE I,S 3105 <br />PIIPUC WORNS <br />Ti�7Al <br />NO <br />�7]�07 _����L- <br />_ __ _ /l 1 _ <br />_ -_-_.__ —__�._ <br />� <br />�: <br />��: h_L� <br />� �', � <br />