Laserfiche WebLink
i N �-3�l''' CONSTf\ U���QN <br />PERMIT APPLICATION <br />COMBINATION BUILDING If MECHANICAL PLUMBING <br />UW NE11 MAIL AUUHLSS ur •---- <br />ZIjS `) PHONE LICENSE NV <br />MAIL ADDRESS <br />ARCHITECT U DESIGNER <br />GENERAL CONT RACTOR MAIL ADDRESS PHONE LICENSE NO <br />MECHANICALCONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />_PHONE <br />PLUMBIND CONTRACTOR MAIL AOD RE 55 LICENSE NU. <br />(PHONE boo <br />Q -w `CSZa L.a o' R Q o '30•l 51a �,. �«L• i_� _�-�3= ') - <br />PERMIT CLASS OF WORK <br />❑CO MOIN ATION <br />❑CUILDI NG PLUMBING ❑MECHANICAL ❑NEW ❑ADDITION ❑ALT EFTA T ION ❑HLPAIR <br />VALUATION OF WORK <br />❑DEMOLISH ❑FENCE ❑SIGN ❑'iWIMMfNG P()OI. <br />( S <br />_ <br />OESCHIOE WORK <br />OTHEK PERµITS OR APPROVALS <br />PROPOSED USE <br />j� RE ZONE 1:1 SPECIAL USE <br />VARIANCE SHORLIIJE <br />LEGAL DESCHIPTIONOF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />--SE PA CHECK LIST REQUIRED <br />I:' YES <br />NO <br />L <br />JOB ADDRESS <br />` 02 s G <br />MECHANICAL. <br />TYPE OF ENERGY <br />❑(. AS ❑ELFC. <br />PLUMBING <br />- _ <br />NO. TYPE OF EQUIPMENT FEE <br />% <br />___ _, _„ <br />AIR :ONO. UNITS-H. P. EA. 1 <br />NO. <br />TYPE OF FIX TUNE OR IT <br />FEE <br />IT F R I ISE R AT ION UN I TS• H. Y. E_A. <br />BOILERS N.P. EA. - i 1 <br />- <br />FORCED AIR SY STEbP_ B_T.V.. IAE A. <br />1 <br />- <br />SP'ACE WALL HEATERS �� A.T.U. ( <br />RATH TUBS <br />S <br />CLOTHES WASHER <br />1 <br />DISH WASHERS <br />1 <br />DRINKING FOUNTAINS <br />I <br />Ft OORDfIA INS <br />_& <br />UNIT I+EATERS R.T.0 <br />EVAPORATIVE COO_LEHS <br />L <br />KITCHEN SINKS & DISP. <br />( <br />IIAIt SINKS <br />ROOF DRAINS RAIN LEADERS <br />I <br />CLOTHES DRYERS <br />1 <br />SHOWER BATHS <br />VENTILATION FAN <br />SERVICE SINKS <br />I -I <br />RANGE HOOD <br />._M_ <br />AIR HANDLING UNIT C.FUBINALS <br />WATER HEATER -. <br />_. <br />_ <br />SUM VS - SEIYAGE PUMP <br />-_-L_-- <br />WATER CLOSLTS.. <br />___ <br />+ <br />WATEft HLATEItS -ELECTRIC <br />1 C <br />'-'- <br />----''_, <br />_ <br />'-FIREPLACE <br />FAC. BUILT FIREPLACE & <br />'—" ­ -- <br />6A5. SY STEM:_N O_ OP OU Tlf.ts <br />� SUIT TOTAL- ...S <br />PE RMIt <br />• •_L__ <br />i <br />WASHBASINS <br />( OU <br />LAUNDRY TRAYS <br />� <br />-- <br />SUB TOTAL <br />THIS PF. fi0.UT BECOh1E5 NUI l AND VOio tl WU)iK +1H f.O NST RUC <br />TIIORIZED IS NOT (.DMML NCFD WIT IIIN 120 DAY]), OR IF <br />(� <br />S )G <br />PEFI M_I T__ <br />TION AU <br />CONSTRUCrION OR WOIIK I!: SU!;Pf'NDED Oil ARANDONEn FOR A <br />PERIOD Of 120 DAYS AT ANY TIME AP TER WORK ISCOMKIENCEU. <br />1 I+ERLBY CERTIFY THAT 1 IIAVL READ AND L<AMINIO NRS AP <br />PLJCATION AND KNOW THE SAME TO III, TRUE ANO COli li(CT. ALL <br />PROVISIONS OF LAWS ANO ONDINANCES GOVEnNING IRIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />GIVE OT. TkiL AVTIIOR TY TO IV VIOLATE OHRMIT CANCEL ES NOT PAUUME TO <br />TI E PH( VISIONS OF <br />TOTAL FEE <br />WATER SERVICE SIZE SLOG. SUPPLY SIZE <br />J K UACK <br />HEAR YAHOSETBACK <br />US! ZUNk <br />LUT AREA <br />VACANT SITE <br />• <br />OYES ONO <br />ANY Ol)IER STATE On LOCAL LAW IILGULATING CONSTRUCTION <br />OR TILE PERFORMANCE OF CONSTRUCTION, <br />TYPE OF CONST. <br />OCCUPANCY (iRUUP <br />UNITTS DWELLING <br />- Aq�-- <br />Xr'NATUtIE <br />SIZE OF BLOG. <br />NO. OF STORIES <br />MA%. BCC. LOAD <br />SIG OF CU RACTOFI OH AUTI+. AC.I:NT DATE <br />_ <br />111/I IUtJt <br />IIA!iEMLNT <br />IIHE :I'{IINK LLIIS <br />REOUIHLU <br />L�%N CII LCK N UMULH PLAN CHLCK ILL <br />❑VFS ONO <br />FLE RECEIPT NO <br />.--.-_.. _.--.-.... .. <br />FEES VALUATION —.FED_ <br />- 1 <br />SPECIAL CONDITIONS: <br />— <br />BUI LOING 4 1 <br />r-- <br />—� <br />�.—�-- <br />- <br />SEPA REVIEW COMPLETE: DYES ❑ NO <br />• PLUMUINO I <br />-- -- 1 <br />1 <br />conla�cfPlannlnq dept. <br />MLCIIANICAL • 1 <br />•• 1•— - <br />_ <br />1 <br />U T / <br />Y11iU11UR ♦lNTIIV N: fIANYlH1lK10 YY. LMMlV10 OM YWNYLI YY <br />OTHER <br />PENALTY <br />JB9 <br />SEC. 1d <br />1 <br />11 1 <br />TOTAL <br />1 <br />1,)4; <br />