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- iLx U; V b; I 1 u t' h 16 i 5� <br />PERMIT APPi iCAT101 <br />COMBINATION • BUILDING • MECHANICAL PLUMBING <br />. / MAIL,aArUU/IkSS ZIY <br />COMBINATION <br />❑BUILDING OPLUM.BING MECHANICAL <br />/ALUATION OF WORK <br />S <br />❑NEW ❑ADDITION ❑ALTEFIANON ❑lIC 1•AIlt <br />❑DEMOLISH FENCE ❑SIGN O!1WIMMINR POOL <br />OUR COPIESi" '" _, `"`4t$I T ISHOW BELOW <br />OR ATTACH <br />.OT ' BLOCK_OF <br />LUMBING <br />IU. TYPE O FIXTURE OR ITEM <br />FEE ' <br />HA111 111115 S <br />CIUIHESWASH R <br />DISH WASHERS <br />, <br />} <br />FOUNTA NS <br />_UftIN.-:ING <br />Ll nnu <br />?I REZONE .:t:[ SPECIAL USE <br />( VARIANCE .j SHORLINE <br />S'E PA CHECK LIST REQUIRED <br />l:r YES <br />I1 NO - <br />MECHANICAL <br />TYPE OF ENERGY <br />OAS ❑E LF.C. <br />NO. TYPE OF EQUIPMENT '�v---T1 FEE <br />_ AIR CONO. UNIU NITS-II.P. E_A. rs <br />nkFRIGERATION UHIfS N.V, EA. —T <br />B01 ERS A.P.EA. <br />FORCED AIR SY S7 ELLS Ft. T.0 <br />HE <br />SPACE G WALL ATERS •• FLT.U. <br />UNIT IIEATE R S B. T,U.—�- <br />SHOWER FlATHS ' CLOn1E5 <br />SE FiVILE SINKS u 1 <br />VENTIL.A' <br />%TER SERVICE SIZE BLDG. <br />11! LOtVE �— <br />LCIAC CONDITIONS: <br />u <br />1 __ •WATER HEATER _•—• - —•" '—"'Z'—� <br />I _ FAC. BUILT FIR EPLACE_*SURIR CIIIM_NEV_ •-L— <br />GAS. SV STEM NO OY OUTLt i5 <br />, PERMIT <br />THIS Pl ii141T BECOMES NULL AND VORi Ii LYUTOTAL FEE S IiY, Ilp C.p NI STRU <br />TION AUTIIOAIZEO IS NOT COMMLNCF D WITIIIN 110 DAYS, OR <br />CONSTntICrION OR WORK IN Stf!;I NOED On ARA NDONED FOR <br />PERIOD OF 120 DAYS AT ANY rIME AFTER WORK ISCOMMENCE. <br />iSE'^;TB A[j' I IIL REnY CERTIFY THAT I HAVE IIEAb AND EXAMINE n illl5 A <br />P LICAT ION AND KNOW THE SAME TO llh TRUE AND CD RREC T. AL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYF <br />.� OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEnEI <br />LO'. VE AUTIIOFi TY TO IV OIATE O3RCANCEL MIT ETIIE Pn(R IS PESME D <br />S NOT <br />ONO ;ANY OTHER STATE On LOCAL LAW HEGULATINU CONSTIIUCrIO <br />.LING On THE PERFORMANCE Or CONSTRUCTION. <br />a <br />BA D <br />x <br />L 111� SIGNATUf1E Or-CONT--OIi AUT I. AGENI bAi.E - <br />❑NO LAN CIILCK NUMBLR PLAN CIILCK ILL <br />I <br />TLc RECEIPT NO. <br />— --_ _ FEES _ VALUATION _ Fr:E <br />BUILDING <br />IEPA REV([W COMPLETE OYES ❑ NO PL 11MfiI N11 <br />cOntoct Pipnnlnq dept. MECIIANICAL-- <br />1 - <br />OTHER <br />ICAl1UH ALUIIIU Y`.•^ IU_y)LIIILYIU YV;_ pYIO UY,YAIAHLIVT—_—`--- <br />, Y PENALTY <br />1 <br />TOTAL <br />mi <br />S 1 <br />I <br />1 <br />SEC. 003 lel I <br />r <br />r <br />a <br />