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I,"PPLICATION FO«' fLPr.„ <br /> the « <br /> CITitY or r tt CONSTRUCTION <br /> OF <br /> e e e PERMIT <br /> BUILDING DEPARTMENT <br /> 2590745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION 4 BUILDING O MECHANICAL O PLUMBING ❑SIGN <br /> IIWNLR/� MA4 AGGRESS CITY ZIP PHONE <br /> A"/c//d•zn //,C"l/r1er � /fit>/,�r•r lu, 0AA,";W. gY771- 7iti-S'�`Z' L:• _ <br /> ARCHI It D10B0 f91GNER MAIL ADDRESS CITY ZIP PHONE <br /> /TTI)k1Nt RA.r 35/G'...tOR J.f as't,y �✓•='.4!7l �i.�'LL'3 _�sS" Jto., <br /> UI HE RAt OF. MAIL ADDRESS CITY ZIP PHONE LKENSF <br /> b.-imer . 'dU,dtli 1(,z. ^xecc 1/i7'l ',IG•Sn,o C. <br /> MECHANICAL CONTRACTOR MAIL ADDRESS Car ZIP PHONE LICENSI <br /> PtUMBINRCONIRACFOR MAIL ADDRESS City ZIP ATONE LICENSE <br /> CI ASS Of WON% <br /> ID NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCA11014 <br /> VALUATION Or WORK IC091 Or MATERIALS MUM LABOBI <br /> 7!' C.x) <br /> UI BCR191 WORK <br /> Ac r,-" <br /> USE M BUIl01//N�10 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> L PLICATIONANDKNOWTHESAME TOBETRUEANDCORRECT.ALL <br /> trUALRtSC§, JNUFPROPERIVISHOWNBELOW ORATTACH FOUR COPIESI PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> Q „ 87 OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> Lot to DIOClOf IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> i GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> 57tc- (>•f.11rt ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OFC NTRACTO/R ORRAAUUttHOQRIZEO AGENT DATE <br /> I'NOJ[Ct ADDRESS APPLICANtS CITY BUSINESS LICENSE NO <br /> COLO k,4 Serra PL.. S <br /> PLUMBING _ _ MECHANICAL <br /> _NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> N _WATER CLOSET(TOILET) AIR COND.UNITS-H.P.EA <br /> j/ BATHTUB 4.Oa REFRIGERATION UNITS-H.P.EA <br /> _ LAVATORY IWASH BASIN) BOILERS-H.P.EA _ <br /> _ SHOWER OAS FIRED AC.UNITS-TONNAGE EA <br /> L KITCHEN SINK&DISP. C1p FORCED AIR SYSTEMS-B.T.U. MEA _ <br /> DISHWASHER dG WALL IIEATERS-B.T.U. M _ <br /> LAUNORYTRAV UNIT HEATERS-B.T.0 M _ <br /> CLOTHES WASHER 4 an I EVAPORATIVE COOLERS _ <br /> WATER NEATER Z CLOTHES DRYERS <br /> URINAL VENTILATION I AN <br /> _ DRINKING FOUNTAIN RANGE HOOD O <br /> __FLOORORAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAKERS _ STOVE <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE&CHIMNEY <br /> SINK SERVICE-BAR ETC. WOODSTOVE/FIREPLACE INSERT --i3 L7O <br /> yTpq �00 <br /> SUBTOTAL S SUB TOTAL t S <br /> PERMIT t PERMIT t ---_ <br /> _ TOTALFEE t TOTAL FEE t BO <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> I NOMF 9r WALK REAR BE(SACK StOESETBAC� PLAN CHECK UMBER P1AIN CHECK r <br /> 1Fl FEE RECEIPT NO <br /> NSI ZONFd J LOT AREA VACANTPaO <br /> SITE O(� o / <br /> 1_ ES ONO RVALUATION f!! <br /> IVPI OF CONST OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> -y <br /> rt] �` •J BUILDING 63 <br /> SOE 01111 MI NO UT STORIES MAX OCC LOAD <br /> r L� `�_� PLUMBING _w <br /> MECHANICAL 00 <br /> FIRE SPRINKLERS REQUIRED D YES O NO <br /> OCHER <br /> PENALTY <br /> AIN'1 RIAOON AGC BY PLANS CHECKED BY APPR FOR ISSUANCE BY <br /> TOTAL <br /> SC'1 G. <br />