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. ` > CONSTRUCTION loo;-1'17 <br />3H6I <br />PERMIT APPLICATION <br />COMBINATION BUILDING MECHANICAL • PLUMBING <br />DVVNLR <br />MAIL ADD14 'S <br />ZIP PRUNE <br />._ <br />UR CESIGNEMAIL <br />ADDRESS <br />PHONE LICENSE NO <br />JAAC <br />ZU - �.-�o++�ON <br />RACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NU..✓AL <br />CONTRA TOFF <br />`:Ez <br />MAIL ADDRESS <br />�7 PHONE \ LICENSE NO. <br />cryz2E-.� � <br />fT // <br />�Y-r ou;,"Z fl l <br />PLUMUI TRACTOR <br />MAIL ADDRESS <br />PHONE ' LICENSE NO. <br />ITERMIT <br />CLASS OF WORK <br />❑CO MBINAT N <br />BUILDING ❑PLUMBING ❑MLCHANICAL <br />NEW <br />❑ADDITION ❑ALTEIIA TIDN ❑HU•nlli <br />VALUATION OF WORK <br />S <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑nWIMMING POOI. <br />DISCHIUL WORK <br />PROPOSED V. <br />OTHER PERMITS OR APPROVAIF <br />�`OF' <br />tIREZONE f-d SPECIAL USE <br />ILGAL OLSCRIPiION OF Pf10PEflTY IS HOW UELOW <br />FOOT COPIES) <br />OR ATTACH <br />{�-� <br />#VARIANCE �--I SN.ORLINE <br />LOT BLOCK —OF <br />� <br />SEPA CHECK LIST REQUIRED <br />]f YES <br />II NO <br />JOB ADDRESS A 1 <br />i MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑f7AS FLEC. <br />_ _ TYPE OF EQUIPMENT FEE <br />----- --- <br />NO. <br />-- <br />D. UNITS-H.P. EA. S_ 1 <br />RLP RIGEq ATION UNITS u.P. En _ ---T <br />OOII ERS 1LP. EA.--��----_--_rt <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />fA 11111)US <br />S <br />CLOTHES WASHER'--�—'T— <br />FOnCEO AIR SYSTEMS B.T.U. MEA. <br />UISH WASHERS <br />-- <br />� <br />._..�.j•,— <br />SPACE & WALL HEATERS <br />DRINKING FOUNTAINS <br />FLUOR DRAINS <br />KITCHEN SINKS & DISP. <br />Ip <br />_ <br />UNIT HEATERS U.T.U. <br />ALIT SINKS <br />I <br />EVAPORATIVE <br />Rool: DRAINS RAIN LEADERS <br />I <br />_COOLERS ___T- <br />'-) CLOTHES DRYERS <br />SHOWER BATHS <br />VENTILATION FAN <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />RANGE 1/000 <br />-_ .-- <br />URINALS <br />I <br />Alfl IIANDLIN(: UNIT C.F.M. <br />WAIGR CLOSETS <br />I� <br />._ ._...___. ....... ...__. ._ __._.. .._ ._......... <br />WATER I/F;41E115 -ELECTRIC <br />1 <br />WATER HEATER <br />VJASH BASIN$ <br />.) <br />PAC. BUILT FIREPLACE W CH161NEY f <br />LAUNDRY TRAYS <br />GAS. SYSTEM: NO OP OU_TLI.IS <br />._ _ _ ... <br />M <br />GUfI TO L S <br />PERMIT S <br />SUBTOTAL <br />-_ T-6i AI. FEE S /1 <br />11115 PERMIT IIECOMS l AND VOID II WUHP. <br />TOTAL FEE <br />NOT <br />TION AUTITION D IS NOT CCIMMLNCID WIT14IN 170 DAYS. OR IF <br />0 DAYS.OR I <br />-- <br />CONST IIlICT10I+ OR fYOf(K IN SU!:Pf'NDED O11 ABANDONED .-OH A <br />WATER SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />PERIOD OF 120 DAYS AT ANY TIML AFTER WOnK IS COMMENCED. <br />FILAR YAROSETBACK i <br />1 HEREBY CERTIFY THAT I HAVL READ AND UXAMINIO TI11S AP <br />PLICATIUN AND KNOW THE SAME TO TIE TRUE AND CORRECT. ALL <br />y}� <br />�D/ - <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF <br />U!:C ZONE Wi A/iLA <br />. <br />YYt/ <br />VACANT SLL -�— <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />On NOT, THE GnANCING OF A PERMIT DOES NOT PRESUME TO <br />-z' <br />[']FES ❑NO <br />GIVE AUTHORITY TO VIOLATE Oft CANCEL THE PROVISIONS OF <br />ANY OTHE STATE OR LOCAL LAW IILGULATIN(i CON!:T AUCTION <br />TYI•E OF CONST. OCCUPANCY GROUP <br />NOOF D .WELLING <br />On THE PE FORMANCE OF CONSTRUCTION. , <br />UNITS /) <br />J <br />SIZE OF ULDG. NO. OF STORIES <br />MAX.00C.CL'OAD <br />' RI& <br />/�16I_IIIL%ONERA::LMLN1 <br />1­1 <br />--- <br />f <br />INL:1HINKI5SRE <br />ifNT <br />/V <br />FICOUIFIEDAN <br />[ <br />C�K/ <br />CHLCK I LL3 <br />PkC _ RECEIPT Nn. <br />V_�-� <br />SPECIAL CONDITIONS: <br />�LAN /CH�k <br />FEES VALUATION - FEE <br />• .. . <br />BUILDING S�j�/�.._ <br />SE PA REVIEW COMPLETE OYES <br />❑ NO <br />PLuMnlNtl <br />I contact plannlnq dept. <br />MLCIIANICAI. <br />OTHER I <br />I <br />AW HCAl1pN ACCITILD YY' RAMi CIIl14lU tlY: <br />7V ROVID OR�IVY <br />PENALTY SEC. 3031.1 I <br />( <br />TOTAL <br />