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CONSTRUCTION . 9/i9177 <br />PERMIT APPLICATION �3313 <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNL11 MAIL AUUIIES> <br />LIP PHUNk <br />AoLi— 9/2 Clever l v <br />�1u.1 `}520� 3s3 �98ro <br />ARCHITECT ON DESIUNLII MAIL ADD(IESS <br />PHONE LICk NSk NV <br />// <br />JoL� <br />II <br />c�lv <br />-- <br />GENLRALCONTRACTOR MAILADDHESS <br />PHONE LICENSENU. <br />11 II <br />/I <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />P LVMUING CONTRACTCJH MAIL ADDRESS <br />PHONE LICENSENU. <br />PERMIT CLASS OF WORK <br />' <br />❑� COMGINATION <br />(pyBUILDING []PLUMBING ❑MECHANICAL <br />NEW <br />❑ADDITION ❑ALTE(IA fI(IN 0IILPn111 <br />VAEGAY164OF WORK <br />DEMOLISH <br />❑FENCE ❑^u1GN ❑':WIMMINIi POOL----- <br />tl <br />--� <br />DESGNIUG ORK <br />Q <br />PnUPOSEO USE <br />OTHER PERMITS OR APPROVALS <br />)I - <br />� <br />II REZONE 4:1 SPECIAL USE <br />#VARIANCE StJ.ORLINE <br />_ <br />A LLOL ULr,,CRIPT ION OF PROPERTY ISHOW BELOW OR ATTACH <br />FDURcoP1Es1 fj <br />��� �TLI✓S <br />LOT BL.CKJ-OF� <br />5EPA CHECK. LIST REQUIRED <br />= YES <br />]ZI NO <br />..... <br />JOB ADDRESS <br />G9I�• AeyCFIV flu <br />MECHANICAL <br />;PLUMBING <br />TYPE OF ENEHaY <br />❑ Is AS ❑FL[C. <br />NO. _ TYPE OF EOUIPMENT� FEE <br />—_ <br />• <br />AIR_ CON U.0TS_.P. E A.-- "S_••---.� <br />NI H <br />RtT I11GF RATION UNITS 11 P <br />..._. _.......--____-- <br />BOILERS II.i. 1 <br />_ FURLED AIR SV ST Ei.13 ILT.V.'ME A. -�--- <br />-•• •-•— ---• • _.—•..- L <br />SPACE 6 WALL HEATERS • R.T.U. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />VAIN i1JUS <br />S <br />_ <br />CLOTHES WASHEA1 <br />1 <br />DISH WASHEIIS <br />1 <br />011INKING FOUNTAINST— <br />FLUGH DfI AINS <br />I <br />UNIT HEATEns H.T.U. <br />_ <br />I <br />KITCHEN SINKS & DISKI <br />IIAR SINKS <br />I <br />EVAPORATIVE COOLERS_T- <br />110OF DRAINS RAIN LEAOL•HS I <br />CLO711ESORYE RS <br />SHOWER DA1115 _ <br />_ <br />VENTILATION FAN 1 <br />SERVICE SINKS <br />RANGE HOOD 1 <br />_ <br />SUMPS -SEWAGE PU :'+ <br />AIR HANDLING UNIT _ C.F_M� �— <br />UnINALS <br />- ..._ <br />_ <br />_ _WATER CLOSETS _ -- <br />_. _._. ._..... __.. . .. -••.• _ •-.. <br />IIEATEn Jr._- <br />WnTE11 HEATERS • ELECTRIC 1 <br />,•_ _WATER _ -. _.- <br />FAC. DUILT FIREPLACE & CHIRINEY I <br />6.SH BASINS I <br />LAUNUFIY TIIAYS <br />_ _ - <br />GAS. SYSTEM: No OP OUTLI.IS--- __ -T—_ <br />_ .. .. <br />•BUR <br />' <br />_ <br />TO ML S I <br />TOTAI. F Ek S <br />SUB TOTAL <br />_ <br />71115 Pf; IirAi7 1IECO�I Er Nlll 1. ANbLVOII) 11 WORK 11H CONSTRUC <br />PERMIT _ S <br />TIDN AU TIIORIZCD IS NOT Co%4MNCI0 WIT14IN 120 UAYS. On IF <br />TOTAL FEE C <br />COY9TIIlICFION OR WORK I;1 SUSPFNOED On AIIANDONER FOR A <br />_ <br />'i!/11.'CmRo.SrERVICE SI7E SIZE— <br />PERIOU Of 120 DAYS AT ANY )IMI: AP TCII IVG(IK IR CGA)ME NCt D. <br />�•rw��_UtUtr)G. SUPPLY <br />>�O¢T1u(U tilS <br />A IIICLISt1UALK RLAH YARD SL tBACK. <br />AP <br />11,AVC OII I, ANT) CrAMINID i1T.AL <br />111!RL BY CERTIFYAND T(1 III, ANP CO n1ICCT. ALL <br />KNOW <br />PROM! ION AND KNOW <br />S ('.O <br />OHDINALACES GDVEnNING TDB TYPE <br />NB OF LAWS AN GnO <br />OF WOIIO <br />COMPLIED WITH tV'IC TIIE II HEn TIN <br />OF WORK WILL COMPLIED <br />_ -^ <br />URL ZUNL LOT AREA VACANT SITI <br />NOT <br />OR NOT, TIIE GRAN 7ING OF APE RAtIi ODES NOT PRESUME TOO <br />n <br />GIVE AUTHORITY TO VIOLATE OR CANCLL TIIE I1110VISIONS OF <br />[]YES ONO <br />ANY 011ILR STATE OR LOCAL LAW IILGULATINO CONRTnUCT1ON <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING <br />Olt THE PERFORMANCE OF CONST HUCT ION; <br />UNITS <br />r,,IZC OF BLDG. NO. OF STORIES MAX. OCC. LOAD <br />'-I <br />GN TUIIC OF CONTf1ACTOf1 DII AUTII. A(iCNT •DATE <br />•1 IIt6 [ONE IIAfit All NT MITI }TI'IiINBNt.01 <br />RI UUIfILD �I•LAN CIILCK NUMIII.n PLAN CIILL'K I' bl <br />❑YL^. ❑NV <br />LPRCIAL CONDITIONS: <br />1 LC 11[CEIPT Nt). <br />�� �O-S Ilk <br />FOES VALUATION FEE <br />1 <br />IIUILUIND <br />' <br />SEPA REV(EW COMPLETE (]YES 13 NO <br />PL UMIII NIi <br />.... ..._—_.._ I <br />I <br />contact planning dept. <br />MLCnnNICAL <br />OTH"n 1 <br />ii?A ICAIIUN ..,It'll U 01 rLA".l.11NLUYY AITWVII, t)K UAk(i It <br />PENALTY SE C. 303111 <br />C <br />TOTAL 1 <br />, <br />