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' UUIVJ I 1 Uuu ► IUIV <br />PERMIT APPLICATION <br />COMBINATION C BUILDING • MECHANICAL • PLUMBING <br />FO-l�C,C;MBINATION <br />Ils+'UILDIN'G ❑PLUMBING ❑MECHANICAL <br />s —/0 0 <br />-C. C. Q.- <br />BLOCK <br />7 5 wis 4w2 <br />JOB ADDRL55 <br />Ll /J7 rf �L-c, L ✓. <br />PLUMBING <br />MAIL AUUIII:4� <br />// l W e,:cg1 <br />IaNEW ❑ADDITION <br />❑ALT E VIA fIUN ❑REI'Aln <br />❑DEMOLISH FENCE ❑SIGN ❑SWIMMIN(i Pilot. <br />ATTA <br />_ f— <br />OTHER PERMITS <br />OR APPROVALS <br />3 REZONE <br />t� SPECIAL USE <br />#VARIANCE <br />hj SN.ORLINE <br />SE PA CHECK <br />LIST REQUIRED <br />I:• Y E S <br />LI NO <br />MECHANICAL <br />TYPE OF ENERGY <br />,o/zi/-77 <br />350z <br />LJ(: AS ❑ELEC. <br />NO. <br />_ TYPE OF EOUIPMENT� <br />FEE <br />NO. TYPE OF FIXTURE OR ITT=F <br />AIR CONO.UNITS-H P, EA.---�5'---� <br />_ <br />I- IIt II 110S <br />EE <br />REFRIGE HN AT IOUNIfS <br />..... <br />CLOTHES VIA SH F. iI <br />_ - <br />ooli [n; 11. P. EA,--'-"'---- <br />----1--- <br />DISH V!A$HEII$ <br />1 <br />I <br />— <br />FU II CED AIR SY STEMS R.T.U. MEA. �--T^ <br />i 1 <br />O It ill �;ING F(IU�JLIIN$ <br />__LEATICE.b WALL LIEATERS �• B.T.0 <br />� T"—'— <br />IJAHSINKS <br />' IIEATEnsHOOF <br />Oft AINS liq IN LEAULI(PORATIVE <br />COOL[115SERVICE <br />J <br />SIN✓.$ <br />IIl ATION FAN �- <br />—ice_-46 <br />SUMPS_ SEWAGE PU:'P <br />GE H000ERCHANDLING � <br />WAIEH CLOSETS <br />UNIT C.F.M. <br />Z-- <br />_ .—..__.... --I <br />WATER HEAT EIIS - F. LE CTIIIC <br />�----. <br />- 1 <br />_ ----' """' '-' •- - ••- <br />WATE_R 11EA_TEfI <br />-_ I <br />� 'T-' <br />YJASH SASiIi$ <br />,-- <br />.., <br />LAUKDilVT1iAY�__ <br />1 <br />_._-...SYSTEM <br />'ijl <br />FAC. BUILT PIREI'LACG w CII IMINEY <br />��- <br />.___... __,,._,. <br />GAS. SV STE M: NO�--T-"- <br />I <br />-_-_ <br />SUII T(1 TAL S <br />1 <br />SUB TOTALL— <br />PE It MIT <br />PEHM1?Ii <br />S �-- <br />7PE fiAll� lIEC01ALS NUI 1. AN0 VOIU II <br />11iS W011✓ <br />OH CUNSTRUC <br />TOTAL FEE <br />TA TER $EHV ICE 517E <br />G �I <br />TION AUt1tORI?EO IS NOr <:O\+MLNC.[D WITTIIN t:`p UAr?:. OR IF <br />CONSli llCtlON On WORK RI SUSI'I�NOED <br />_-SLOG. <br />TJ ALZ <br />SUPPLY SIZE <br />On AEIATJ('aC0 FOR q <br />O <br />PERI(iD Of: 120 DAYS AT ANY Ilbt F.' AF TCH WORK I :CO'.t r,1EKCE D. <br />I IIERLBY <br />LIGACK <br />IIEAH YA{lU SE <br />CERTIFY THAT T IIAVE RLAD ANO EXAMINED TRiS AP. <br />PLICATION AND KNOW THE SAME <br />JSf TUNE _ Ul WfL- <br />L <br />VACANT <br />TO III, TRUE ANO C01:11'CT. ALLI <br />PROVISIONS OF LAWS AND OIIOINANCES GOVERNING TIPS TYPE <br />I OF WORK WILL BE COMPLIED WITH WI(ETHEH 'PECIFIEO <br />SIT! <br />❑YES <br />IIFnri CI <br />Of( NOT. Tilt GRANTING OF A PERMIT DOES NOT PRESUME TOI <br />GIVE AUTIIOI:ITY TO VIOL <br />TYPE UI CO NSI, OCCUPA- Y GnDUP <br />[]NO <br />IUD, OP UWE—LI NG <br />AfC OH CANCEL TILE 14TUVISIONS OF <br />ANY 07 HL'(1 STATE On LOCAL LAW HLOULATING CONSTn UCT10N - <br />OD THE PL{1FCHMANCE OF CONS711UCl ION. yJ <br />UNITS <br />IIZC OF CLOG. NO. OF Sl DRIES <br />MAX, OCC. LOAD <br />i� q �q <br />T"L ZOfJI—`-- - <br />XONATIJ �VCfi <br />IIA:�l MLNI <br />{ IHf. ?:1'{1INIP 1.I.1{y <br />LOF CUNT nACTOIiCN AUTII. AGENT DATE <br />_ <br />REOUE D <br />❑YC S []NO <br />,I <br />_ PL.VJ CHL CR (UU M1:ULf/ <br />i�' LAU til...,� PLAN CIILCA I LL <br />J'LCI AL CONOI TI ONS: <br />_..-- HUILDING <br />SEPA REVIEW COMPLETE:DYES ❑ NO I'LDMnIN(I <br />ContOcl Plannlnq dept. M/LCOA NICAL <br />OTIICII <br />�IICAII411 µL111lU tlF. rUMY Le II N UYY urHU\IU Un p•wtuSl tlY <br />----_. PLNALtY <br />TOTAL <br />ilC , <br />VALUATION <br />IIECEIPT No. <br />-.-_ FEE.T...� <br />s � <br />t <br />1 <br />I <br />• 1 <br />' I <br />. 1 <br />SEC. ]Bp 1•I I <br />I <br />