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_...`` �1PPLICATION 1`01% YYET�R <br /> IAPEV610"R CONSTRUCTION <br /> CITY or <br /> CITYt PERMIT <br /> everetTO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br /> L PHONE _ <br /> ILA <br /> 0 <br /> OW <br /> CITY III• PHONE <br /> MAIL ADORAE <br /> A I ECT D%IGNER 1C <br /> if AILAGEHCML CONTTQ.! ZIP PHONEMECHANICAL CONTRACO <br /> MAIL AODPf SS GIN <br /> MAIL ADDRESS <br /> PLUMBING CONTRACTOR CITY <br /> IIP PHI <br /> CLASS OF WONK _ <br /> ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUIL./DING RELOCATION <br /> l. <br /> VALUATION OF RIC IGF MATE It,: PLUS LABOR � Afj <br /> DESC I EWO K �"— � If (JI/CJ <br /> USE OF SIyLDINO (•`TY/ I HEREBY CERTIFY THAT I HAVT_ READ AND EXAM114ED THIS AP• <br /> &I PLICATIONANDKNOWTHE SAMETOBETRUE ANDCORRECT.ALL <br /> VISIONS PRC <br /> OF LAWS AND <br /> THIS TYPE <br /> LEGALUESCRI KINOF PERnISHOWN Lu.ORAT/ACHFOURC-PIE81 OF WORK WILL BE OMPLETOFFDWI HWHEIHERSPECffIEDHERE• <br /> LOT—BLOCK_—OF— IN OR NOT.1 HE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUREOFCONTRAC101I OIl AI IIIOFUZEU AUENI DATE <br /> APPIICA FB CITY BUSINESS LILENSE NO <br /> PROJECT ADDRESS <br /> MECHANICAL FEE <br /> PLUMBING FEE _ NO. TYPE OF EQUIPMENT - --- <br /> NO. TYPE OF FIXTUREAIR CONO.UNIT _ <br /> WATER CLOSET Trill FTI REFRIGERATION UNITS-H.P.EA <br /> _ BATHTUB BOILERS-H.P EA <br /> LAVATORY WASH BASIN OAS FIRED AC.UNITS-TONNAGE EA , <br /> SHOWER 00 FORCED AIR SYSTEMS-07.U. MEA <br /> KITCHEN 91NK6 DISP. p0 WALL HEATERS-B T.U. M <br /> / DISHWASHER UNITHEATERS-BT.0 M <br /> LAUNDRYTRAY -- EVAPORATIVE COOLERS <br /> bQ r <br /> CLOTHESWASHER CLOTHES DRYERS <br /> WATER HEATER VENTILATION FAN �7 <br /> URINAL RANGE HOOD Y <br /> DRINKING FOUNTAIN AIR HANDLING UNIT- C.F.M. <br /> FLOOR DRAIN STOVE - <br /> VACUUM BREAKERS METAL FIREPLAC CIIIMNE_Y_-- <br /> ROOF DRAINS-RAINLEADERS WOODSTOVEIFIRI ACEINSERT <br /> SINK SERVICE-BA ETC _ NN <br /> m <br /> BEI-TOTAL OD <br /> SUB TOTAL <br /> PERMIT <br /> PERMIT E TOTAL FEE <br /> TOTAL FEE 0 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> MAN CNECr FR r <br /> PLAN CHECK NUMBER FEE 116RECEIPT NO /29 V' <br /> FRONT SETBACK REAR SETBACK BIDE SETBACK ) <br /> O VALUATION FEE <br /> USEZONE LOT AREA VACANT SITE FEE! <br /> OYES ONO <br /> nPE OF C;NSI I jp No <br /> OF DWELLING UNIT! <br /> V I\ ALTA RI BUILDING ! 7E • r5 <br /> BIIE OF BLOC NO OF STORIES MAX OCC'10� PLUMBRIO (o Qv }7+SI <br /> NA N <br /> MECHANICAL Q� <br /> FIRE SPRINKLERS REQUIRED D YES (d'N0 OTHER K <br /> PENALTY — <br /> I S� <br /> APPLICATION ACC BY PLANS CHECKED BY APf R Too IISUANCE DL I <br /> TOTAL <br />