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CONSTRUCTION <br />PEUAT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />6 i'f/A_ /(2 v - <br />-I <br />❑ COMB INATION <br />ISXBUILOING ❑PLUMBING ❑MECHANICAL <br />: FOL)R COPILS) <br />LOT BLOCKS -OF <br />I <br />/. /L- S. <br />PLUMBING <br />L <br />o <br />6ti!-`a, SOU U <br />PHONE <br />LICENSL NO <br />�y-�, <br />PHONE <br />LICENSE NU. <br />�L/_d3oL� <br />Do-�Eh-Lz- 23l <br />PNONE <br />LICENSE NO. <br />cunNF <br />LICENSE NU. <br />❑ NEW ❑ ADDITION <br />❑DEMOLISH ❑FLNCI <br />zALTEFTERAr1UN-- ❑REPAIR <br />❑SIGN ❑'%WIMMIN(: POOL <br />)THERPERMIIZ) UKHrr KUYHl� <br />jI RE ZONE tj SPECIAL USE <br />VARIANCE .-1 SHORLINE <br />SEPA CHECK LIST REQUIRED <br />J- YES <br />rj NO <br />J�V-e,-Cfr ow/x/ 1 I <br />7r- MECHANICAL <br />6J� <br />TYPE OF ENERGY ❑I; AS ❑FLEC. <br />F NO. -_R_ _- TYPE OF EQUIPMENT - • f FEE ' <br />AIC_ONO. UNITS-H.P. EA• -_ _ _--.T---- <br />;M FEE REFRIGERATION UNI IS 1_.PEA. <br />S 001LESS HP. EA.- <br />FORCED L!IR SYSTEMS n-T.U_ MEA. �- <br />-- <br />! SPACE & WALL HEATERS -- fl.T. U. <br />UNIT HEATERS B.T.V. _ ..� r�- - <br />EVAPORATIVECOOLEHS _. l <br />I CLOTHES DRYERS -_--11---� <br />- VENTILATIONFAN T <br />ac nv n.o au...•, - - - <br />SUMPS - SEWAGE PUMP AW"EtNOLINGNGUNIT_ -_ __-•, C;P. M• <br />WRIER CL05CTS _-_ WATER HEATER _ .._• _ ---1-�'- <br />_ NIATEII IIL ATE IIS -ELECTRIC 1 FAC. BUILT FIREPLACE !4 CHIMNEY _ _ <br />1VA$H 6A51N$ I - - A - . -. <br />OAS. SYSTEM: NO OP OVTII.iS <br />L AUNORY TRAYS 1 - ---�-- -SUn TOTAL-S-,--._-T�- <br />_-- -•.__ -ER- T <br />SUB TOTAL I T111S YF. fi MIT UECOM ES Nlll 1. AND VOID 11 WORK OH CONSTRUC <br />_PEli h1_I T__ S� TION AUTHORIZED IS NOT COMMLNCEO WITHIN 110 DAY!;, OR IF <br />C <br />TOTAL FEE CONSTRUCTION OR WORK IS SUSI'CNOEO OR ARANOONEO FOR A <br />PERIOD OF 120 DAYS AT ANY flMt AF TER WORK 1!t CDMf•IENCLD. <br />WATEF' >Fr VICE SIZE SLOG. SUPPLY SIZE 1 Ht REHY CERTIFY THAT I HAVE IILAD AND 1:<AMINIO THIS AP <br />\LK UAL-K (SEAR YAROfiLTUACK PLICATION AND KNOW THE SAML TO IIL TRUE AND CURR('Cr. ALL <br />PROVISIONS OF LAWS AND ORDINANCE% GOVERNING MI5 TYPE <br />' OF WORK WILL BE COMPLIED WI fR WHETHER SPECIFIED HER I% <br />LU7 AgLq VACANT SITk OR NOT, THE GRANTING or A PERMIT DOES NOT PRESUME TO <br />USf ZUNL GIVE AUTHORITY TO VIOLArk OR CANCLL THE PROVISIONS OF <br />OYES ONO ANY OTIIF-R STATE OR LOCAL LAW IILGOLAT1Nli CONSTRUCTIOF <br />NO. OF OWDWELLING,OR THE PERFORMANCE Or CONSTRUCTION <br />T' <br />YPE OF CONST. UCCV FANCY (:RUUY UNITS p <br />SIZE OF BLOC. NO. Of STORIES MA%. OCC. LOAD <br />✓L(� p <br />ATUEOF CON T R AC TO It O IS UT AILAG E N'F.. GATE <br />FI <br />-- <br />IItL ZONk <br />- -- _ <br />IIA.�E ML NT <br />IIHL);1IHNKLUC: <br />HLOUI REU <br />❑YEr_- ONO �V <br />LAN C/IL CK INK1ULf1 <br />PLAN <br />a� -ll <br />FL/ <br />CIILCK ILI <br />IIECEIPT NO <br />.. <br />SPLCIAL CONOITIONS: - <br />iii FFFs <br />L <br />VALUATION <br />—_FF.E— <br />SEPA REVIEW COMPLETE: OYES ❑ NO <br />contact plannlnq dapt. <br />WLICAbUH AU 1 R 10 YV1IA 5LHIUIUYV AMIIOVlO UK IhM1l1AK1 YY <br />If N,W•M F <br />BUILDING <br />PL UMIII NO <br />MLCHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />S l <br />1 <br />1 <br />1 <br />I <br />1 <br />SE C. 30:1"1 t <br />r <br />