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- CONSTRI�CTlO� �� /- r ' <br /> . � '� d <br /> PERWilT APPLICAT(ON ; <br /> COMBINATION • BUILDING • MECHANICAL • PLUMBING , <br /> MAILAUUNkiS LIY YHUfVt , <br /> ��OWN � <br /> 1�bn�1(iNE lT."4f� ,��//����.j _ � . ��cE s�u J <br /> A GHITE 7 MAILA6DHE55 PM NE <br /> MAILAD�NE55 /NJNE LICENSF NU. <br /> GE A C TR A � ( � ' <br /> ��� y p ��Y�zI�Y�'l�-- _ <br /> ECt1 NICAL N RR M1A1L ADPilE55 PMDNE L�CENSE NO. <br /> PLUMtlING CONTRAGTOfl MAIL ApDPE55 PMONE L�CENSE NU. ' <br /> VkRMIT CLASSOF WORK � <br /> �COMBINATION <br /> �OUILDING �PLUMBING QMkCHANICAL ❑NEW OpDD1TIUN �AL� TE��nf1qN_ ❑��U'��i� I� <br /> VALUATIONOF WORK 1ViMMINt: NOOL, <br /> � 1 ❑OEMOl15H ❑FENCE ❑SIGN ❑': <br /> s 7�D �� — , � <br /> DESCRIUE'WO K /� � / <br /> -�/�� � �,�• � . � / ... <br /> 7� <br /> vn sEo use, ' OT ER PERNI�T5 O APPR VAlS • �� <br /> �`Z�� .j� REZONE � SPECIAL USE � <br /> FOUR CO�IESI�PT��N OF PROVERTY ISMOW BEIOW OR AtTACH }"F YARIANCE � SNORLINE <br /> �� <br /> �or e�ocK_oc SEPA CHEGK LIST REC�UIRED <br /> �' YES . � <br /> � NO . <br /> ioo nocr+es� <br /> -. ,,.�� � .� � �MECHANICAL <br /> TYVE OF ENEPGY ❑�.^� �CIEC. <br /> PLUMBING - "'—� FEE <br /> , ND. T'PE OF EOUIPMENT...._,._}5 .._ t <br /> AIRCOND.VNITS-M.P. EA• _� _ __��_ <br /> qp, 1vFE ^FFl%TUREORITEIA FEE �_ REFPIGERATIONUtJILS_H�. GA �_ _�_�_�} <br /> $ OOItERS H.P. EA. _-- _�_y____ 1 . <br /> Y.nIN ii;titi � . - - T� . <br /> ClO1f:Fy V/l15HEN FOR�ED AIR 5�57EM'+ 17.T.U. MEA. }I� __L <br /> UISN 5':AShE115 � ' -..- " _ 1 -�{�� <br /> UHINSIHf} FOUNTNNS � _ <br /> SVACE b WAIL NEAiEHS �� P.T.U. I � <br /> FI OON UHnIuS � J: __ � <br /> � UNIT 11EI�TEP'a H T.V. _� ��� <br /> KITI:��FN tiINK51L OI�P. I Ey(�vOHnTtVE COOLEHS ' � <br /> 11Aq SINY.S - � �J--____.___'""__- 1 <br /> IIOOP DRAlIJS Nf11N LEAUEA$ i __ CIOTnES D�YERS �_� T�- <br /> � <br /> SHn�':EH flATHS ' ��_, _'� VENTIIFTION FAN � - <br /> PANGEHOOD � � <br /> ti[RVIf,E S�N✓.5 . ._ -� <br /> SU�JV__- SE�'�AGE {'UMP AIH IInNDLING VNIT.� .. ..-._ C./.M. �.�I�.._` ' � <br /> Uf1iY�L$ -" ' .__ , . .�_ - �"' � 1 <br /> ! _ _ ""_" '" ".. • ^—'—r_. <br /> WA1[NCIOtiLTS WATERHEATER _ . .. ._�.J---- <br /> WAT6R IIF:.TF.IIS � ELECI'HIC � -' - - ' " -"' t <br /> WAiM BPF��lS ' FAC. BUIIT FIREPLACE M1 CHIMNEY <br /> �� �- GAS 7�STEM: NO OY DUTL�.�S �-- T—�- <br /> �_� <br /> LAUNURY TIIAVS � - ._'."-- ... •^Uf17OMl S 1 <br /> _ � --- � VERhtIT S �__T- <br /> - � - ---'—��'-� �':TOTnI F E E 5� ___ � <br /> SUf1 TOTAL � T��i.S VEiVnIT�UECOMES NUI I ANO Vn�U �� W����K ��p ������STRUC <br /> pERMIT 5 TIDN AVT��OnIZED IS NOT C:U`44�tN�LD W�T1aN 170 U���. nA �F <br /> TOTIIL FEE ' CUNSn�UCi�ON OR WoltK C� .U::�'CNDE� OII AOn���OtiC� �P� n <br /> WAT[R SEFVICE SIIC BL�G SUPPLY SIZE PEn�Oo oF �7o D��S ni nNv tiMF /��Tt��W0f1K �::CP'.1•dENCEU. <br /> � I IICRtIIv CERTIfY iNAT I IiAVf: IIEAU nND E`�nti11NfD Tlli: A7 <br /> � � M1 TIIAIA Mhi�H YANU5t10AGG p��C/��ION AND KNOW T11E :A1.'E TO NL TfWE ��Np CO����f fL ALL <br /> PROVI:IONS OF LA.bG ANU OfiDINANC2$ GUVE�4�NG Ti�i$ TYVE� <br /> OF YIOiaK �'��ll BE CO`•�P��EU WIT11 WMETHE�i SFECIFIlD HE�EiNi � <br /> WC ZUNL lU1 Al1�A V/�CANi 9�Tk � OR NOT, iHk GfiAN"ING OF A PERMIT DOES YOT PNESVME TOi <br /> GIVE AUTIIOrtrtY TO VIOIAfh ON CANCkL T11E MFUViSiDNS OFI <br /> • � � ❑YES ❑NO � ANY OTMER STATE Ofi L�CAL I.AW ��LGVLAi1Nli CONtii11VCTION <br /> pP iNE 4Efif ORMANCE Oi CONSf NUC710N; <br /> TYPE UF CONST. OCCUPANCY GROUP MO.OF DWELLING � <br /> UNITS � <br /> SIZC OF OLOG. NO.OF STOHIES MA%.OCC LOnO l� �� • ��� ���� ���)/J- <br /> ' �'_.�lCl_ �� �� <br /> 9'iGJi/1TUfi FQO ��nCTOIIORAUT11.nLENT OAfEf <br /> �I IIIL ZONt ilA::kMLNT ' 111[F:I'H�NKLl115 VLnN LIILCK Fht . <br /> . REOUIHEU YLANC1�tCR IVVMUGf1 ��ECEIPT NO. � <br /> � . � ❑YES ❑NO {kC <br /> SPlC1Al CONOITIONS: . ... _ . -� "- <br /> � FEES VALUATtON �_FEE <br /> --r- -T <br /> - � <br /> ----- _._ ___ •— ---i D� <br /> uuuou�c s�? '_v O � <br /> ----- � _ . ._ � ---- -' �"i"._ <br /> SEPA REVIEW GOMPLETE � ❑YES ❑ NO ' P1U61111N17 -'_V.. . �. <br /> i <br /> Contact Plann�nq depl. Mcc��nr::�-n� . _ �-_... <br /> t <br /> � OT11CR � <br /> SEC.�0.1 IQ � <br /> �uunu»��uriw�� Y�/1MiCNlla\YYV �x�ovlo oeuw�K.i�r PENALTV -�� '_ _�_,..,..L_�. . <br /> 1 <br /> , . � � � TOTAL -..__.. �`� � / i <br /> _ � <br /> �""' ____'_... �___'._ "'. '. <br /> � <br />