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APPLICATICO FOR CONSTRUCT(PN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />I HEATING SYSTEM: OAS ❑ ELECTRIC ❑ _ <br />2598810 <br />DEMOLITION ❑ COMBINATION BUILDING I:I MECHANICAL ❑ PLUMBING ❑ SIGN <br />DLA , - - f•_ %, ATnM1.'1HC'I. cFGh-_1 6)nl � LID -6090 <br />PLIMeN T"A TO" MALADD w Crtr I, HONE MATE LICENIEF <br />CONTWT FREE 0•Nd11t t�L/j�(lno <br />vAOE <br />O <br />o IJo <br />0 <br />O[fCaN apaLv CHAR[ OOJI NVOIL.,YEVO <br />\ <br />OP1NiCiR SON 1New4R M0 <br />J�]Y <br />— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND CRDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COVPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AU MORIIED BY THE <br />OWN OF THI PROPERTY TO PERFORM THE WORK FOR WHICH <br />APP I AT MADE AND I COMPLY WITH THE STATE <br />C If P7 RCW AND 2SB I00 AC <br />. �l y <br />L I <br />Padouo usF ar euaowD <br />lF6U eflCRwr KMOr PINIVFNh IwGWrl e[LOW MPrT/LN IYq CMaSI <br />LOT e t A a <br />J <br />/ I u ,� O I �O'ZL+ _ �bD <br />"1 l <br />PAaLFL rA <br />caNsrauO Lo�L�roLa Apy{e*rtL raluesa <br />PROJECT ADDRESS;; ��,--,���`� L. <br />95 =, -�i <br />un euwo,iuww <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AC—AMNDLO UNITS—H.P <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU. M EA. <br />LAVATORY (WASH BASIN( <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />I CLOTHES DRYERS <br />KITCHEN SINK f DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />SINK I..2RVICE—BAR. ETC.I <br />SUBTOTAL S <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY' / A/./.1• _!' , <br />f11p1�Y1, / -- <br />PfIJ. Bf reAP <br />5 <br />PDE MieA[A, <br />FUN CHECA ;/ / <br />rc! <br />atCA.�, ^O <br />of <br />ass 1pK <br />rot AKEA <br />1} POb <br />retort MR <br />i� YES ... NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />5�0T1. <br />n <br />tm mm�t <br />ra aeTOKKe <br />mw• nonw,wLwR <br />g <br />m mNDO <br />Si <br />rA; ePRN1FR4 afa0 <br />✓•• <br />eA9IMENt <br />YES 7 NO <br />MECHANICAL <br />ADDHKXIAL PLAN CHECK <br />���L/ <br />Occa rLOAO <br />rw[uAW P[OD <br />{ <br />NFNWtrwRNW <br />REAAON <br />& I& <br />SIME BURDINO SORCHAAGE <br />i5J <br />.RAKE er <br />nMgp AhrwwEDK. <br />�rrq <br />--jy <br />CITY OF EVERM <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBIC WORKS <br />TOTAL <br />' <br />