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- CONSTRUCTI06J <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />❑COMBINATION <br />[�, OUILOING � PLUMUING ❑ M6CHANICAL <br />VALVATION OF WpqK <br />S <br />DESCPIOE WORK <br />' Ro 5i��'n.2�,o /-{ouso " °� <br />PROPOSED USE <br />LLGAL OlSCRIPTIONOF PROPERTV (SHOW BEL <br />FOUR .C�OyPIE51 y ��� ��� <br />LOTd.L—BLOCK_LOF_S_�1lJ[r G ) <br />y � <br />JOP AODNE55 <br />_� ���ef F/OIM �Y1n SI� <br />PLUMBING <br />3i �� <br />��3/��7 <br />�, <br />❑NEW ❑ADDITIUN ❑AL7Etil�hUN ❑I�LI'nIR <br />❑DEMOUSM ❑FENCE ❑$IGN ❑•;WIMMINf: f•t10L, <br />✓ � OTHER PERMITS OR APPROVAIS <br />j� RE ZONE � SPECIAL USE <br />UR ATTACH <br />S #VARIANCE � SF'.ORLINE <br />SEPA CHECK LIST REOUIRED <br />if' YES <br />� NO <br />MECNANICAL <br />TYVE OF ENERGY <br />[, .Ae ❑FLEC. <br />� _'_"....._.._.'"'__ <br />NO. TYPE OF E�UIPMENT FEE <br />.. AIRCOND.UNITS-H.P.EA. - ""—"""'_'S'�—'_— �-- <br />,__ ..._....._'"_.. _'_' "'_" ..._____.-.-' .___t—� <br />HkfRIGEFATIONUNIfS IIV.t4. '_"___1 <br />_ _ _'"""_'____'__ ""'_"._'_'__... <br />OOtLERS H.v.FA. 1 <br />FORCED Alit SYSTEM (1.T.V ME4. --T-- <br />_"'_"__ '_" _' "'_'""' _L_ <br />— _—_' __ I <br />� SPACE d WALL HEAiERS H.T.U. �� <br />UNIT IIEATERS N.T.U. I <br />EVAPOHATIVECOOLEHS —T— <br />. __ L <br />CLOTNESDR�ERS � I <br />VENTILATION FAry � T— <br />_ _'_'__'__"'___ <br />AIR IIANDLINC UNIT C.f.M. _^�_` <br />_...._"'_'__—'___.._ . _... ..."".._." "_"_" <br />1 <br />.. ... . _....__'. ._.... ._. .. _....... _.. .... .�T_ <br />WATER HEATEN _,..y__� <br />.._. _. . _.. ._..._"".... ' '_... _ ._. <br />FAC. BUILT FIREPLACE !4 CNIMNE�' � <br />CAS. SVSTEM: NO OP DUTLf.15 —r <br />�_ _ "" '_ . . .. . .. . . ___c ._ ...... ....y_ <br />SU6TOML 5 I <br />___... __' e ;.-.�� '_ _'""""__r__ <br />_ — 1 _'___'______ __TOTl�L PEE 5 I <br />SUO TOTAL � -7��1 : Pf.fUd1T IIECOMES NUI L AND VOIU tl WUIIK t1H f.ONS�RUC <br />PERMIT a T�pN AUf110f11YED IS NOT COMAILNCCCI WIT111N 1?0 U\V5. OR IF <br />TOTAL FEE CONSTPUC�ION OR WORK q; SUK�`f:NDED OR AOI�NOON[D Fpq q <br />TEfi SERVICE SIZf. BLDG. SUPPLV SIZE 3'ERI00 OF 170 OAYS AT ANV fIME AFTF.N IYOfIK �!:C(1ht!dF.NCEU. <br />� t i�. A K HLAHYAHOSlTBACK ����Rlliv CEnTIFY THI�i I IIAVE HEAf) AND E'(l�MINID i1115 nP <br />�. P�ICATION l�ND KNOW THE ;n�tE iOl�h 7HVE nrip CO�aRfrT. Al.t <br />VROVISIONS OF LAYlS ANU OfiDINANCES GOVERN�NG T1115 TVPE <br />OF WORK W1Ll BE COMPUEO WITH WMET�iER ::PEC�FIEU MEREIn <br />E%ONf Ltl7 ARLA VACANT SITk Ufi NOT, THF. GfiAN.-ING OF A PERbIIT DOES NOT VRESV�AE TO <br />� ❑VES ❑NO : ANv O7/1Ef1 .STIATETORVLOCAlE1.l�W HEGVIATiNG CONtiT11UCT10� <br />PE UF CONST. OCCUPANCV (:NUUV NO.OF DWELLING OR iHE PERFORMANCE OL CCNSTFlUCTION. <br />...�.�.. / <br />SPECIALCONDITIONS: <br />❑NO <br />SEPA REVIEW COMPLETE � ❑YES ❑ NO <br />conlacf Planninq dept. <br />0 <br />x <br />SIGNATURE Of CONTRACTOi10R AUTII. 4GENT <br />itC I��ECEiPT Nn. <br />_ ""_._...___._.._ ,. .. . _. . ... ..... <br />FEES __ VALUATION _ _ FEE <br />BUILDING <br />rwrnmNu <br />MLCIIANICAL —_ <br />OiHER <br />VENALTV <br />TOTAI <br />s S�p�� __�i oU <br />---� •— -- r-._� <br />i <br />i <br />i <br />. � <br />.. �.. _. <br />i <br />SEC_�071N_.. _...�---..._.. <br />d0 <br />t <br />e <br />