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CONS I RUCTION <br />ION <br />F"i"PA T APPL11kCA%. (tD' <br />COMBINATION • BUILDING Y MECHANICAL • PLUMBING <br />OWNERMAIL AUGHI;SS <br />LIP PHUNL <br />C` -j <br />ARCHITECT UH DESIONEH MAIL ADDRESS <br />PHONE LICENSE NO <br />GENERAL CONTRACTOR MAIL ADDRESS SeAAkk- <br />PHONE LICENSE NO. <br />AL•- 'eVl2 Cons\ P,0 .%Lm ZZ3 -C�j A46C_Ntl39(, <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />PERMIT <br />CLASS OF WORK <br />❑COMBINATION <br />ABUILDING ❑ PLUMBING ❑ MECHANICAL <br />❑NEW <br />❑ADDITION ❑ALTEIIn TIUN ❑HLI'N11 <br />VALUATIONOF WORK <br />[I <br />❑FENCE []SIGN ❑':WIMMINO POOL <br />S <br />DESCRIBE <br />PROPOSED USE <br />OTHER PERMITS ORAPPROVAIS <br />1:1 RE ZONE tj SPECIAL USE <br />' <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />FOUR COPIES) - <br />•-� <br />aVARIANCE 1{1 SFORLINE <br />LOT BLOCK —OF <br />S.E PA CHECK LIST REQUIRED <br />ET YES <br />]::1 NO <br />--L-- <br />JOB ADDIiES _—• <br />!MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑f: AS ❑ELEC. <br />TYPE OF EQUIPMENT FEE <br />' <br />NO. <br />- <br />_ _ __� <br />__Ts <br />AIR COND. UNITS-H.P, EA. 5_ 1 <br />REFRIGERATION UfViTS -H V En, --�— <br />1 <br />BOILERS H.P. EA. <br />FORCED AIR SPSTEMS O.T.U. tAEA.-T_ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />HA Ili TUBS <br />S <br />_ <br />CLO THES�•-_-�•--_«-�-- <br />YlASHER <br />' <br />DISH WASHERS <br />I <br />••--- -'"' -'--- _ <br />— ---•- ----• ----'— <br />SPACE 6 WALL HEATERS A.T.U. <br />I <br />DRINKING FOUNTAINS <br />1 <br />-T <br />I <br />FLOOR DRAINS <br />I <br />KITCHEN SINKS & UISP. <br />1 <br />UNIT HEATERS R.T.U. <br />RAR SINKS <br />I <br />EVAPOHATIVE_COOLERS <br />_ <br />110OF DRAINS RAIN LEADERS <br />I <br />CLOTHES DRYERS --y1-- <br />I <br />SHOWER BATHS <br />_ <br />VENTILATION FAIY <br />{ �— <br />SEI(VICE SINKS <br />RANGE HOOD <br />I <br />SUMPS - SELVAGE PUMP <br />AIR HANDLING UNIT_ C.F.M. <br />�- <br />__...---- r— <br />URINALS <br />WATER CLOSES$ <br />- i-AT-Y—'ER H•-• <br />WEATERSELECTRIC <br />..-- <br />_ _ <br />WATER HEATER_- <br />-. _. <br />EV_ <br />FA C._BUILT FIREPLACE N CHIMNEY <br />GAS SYSTEM NO I OU TLI.IS _ <br />I _ <br />T <br />1 <br />--- <br />— <br />IVASH BASINS <br />1 <br />LAUNDRY TRAYS <br />LAUNDRY <br />SUBTOTAL I <br />TIRS II BECOMES NUt AND VOID 11 WORK OR (:UNST <br />PERMIT S <br />n I <br />ito NOT CDMME.NnE WITHIN IAA IZO DAYS. OR IF <br />TION AUTIIO <br />A <br />TOTAL FEE S <br />CDNST RIIC TION OR WORK IS SUti1`CN000 OR AIIA NDDNCD FOR A <br />N O W RK <br />WATER SERVICE SIZE BLDG. SUPPLY SIZE <br />PERIOD OF 120 DAYS AT ANY TIME. Al- TER WO(IK IF COh1S1F.NCEO. <br />I IIERLnV CERTIFY THAT I IIAVE REAL) AN CXAMINLD TIIIB AP <br />U I: U"I. S IIL BACI: REAR YARiU Ski TNACK, <br />PLICATION AND KNOW THE SAME TO III: TIiVE ANl1 CPRIITCT. All <br />PROVISIONS 01' LAWS AND ORDINANCES GOVERNING iH!S TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN! <br />^_ <br />LO7 AREA VACANT SITE <br />OR NOT. TIIE GRAN71NG OF A PERMIT ODES NOT PRESUME TOI <br />GIVE AUT11UIi1TY TO VIOLATE OR CANCEL TIIE PIIUViSIONS GF <br />' OYES ONO' <br />ANY OTHER STATE OR LOCAL LAW IICGVLATIN(i CONST AUCTION <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING <br />UNITS <br />OR THE PERFORMANCE OF CONSTRUCT ION. <br />I' <br />P' <br />SIZE OF BLDG. NO. OF STORIES MAX. OCC. LOAD <br />. O <br />! <br />11NE ZONt IIAGk MLIJT ED RSPHINKI.I ItS <br />. SIGNATURETUREO RAUTH, AGENT NATE� <br />' RLO ikU <br />Y!S ONO <br />PLAN C/IE 'R NVh1ULT1 'PLAN CIIl CK F1:L <br />1 <br />SPECIAL CONDITIONS: <br />ILE RECEIPT NO <br />L <br />FEES VALUATION FEE <br />BUILDING <br />SEPA REVIEW COMPLETE; [] YES ❑ NO , <br />PLUMBING <br />.. ��.. 1 <br />Contact dept. <br />MECHANICAL <br />1--••- <br />plonnlnq <br />_.. <br />• 1 <br />on1r:R _ I <br />AIYIICAl1UM All, I1lUMY: YIAkIC"ILNVYT AMNvInfum 11Awl IIY <br />PENALTY SEC•QBU IYI <br />TOTAL I <br />E <br />