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�cr��TRUC-Ti011 <br />• <br />PERNJT tPPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />AflC111T CCl UI{ ULSI(iNEFi <br />PCVIMUING CONTRACTOR MAIL ADDRESS PHONE LICENSE No. <br />YENMtT CLASS OF WOHK -_-_-- <br />❑COMBINATION <br />❑OUILDING []PLUMBING ❑MECHANICAL [I NEW <br />2rAODITION ❑ALT E IIA I ION ❑Ii LI•A111 <br />VALUATION O F WORK <br />cam_ ❑DEMOLISH ❑FENCE ❑SIGN ❑iWIMMIN(i POOL <br />A%L'p'lC '� <br />Y{iDf' SEO USE OTHER PERMITS O APPROVALS <br />REZONE tq SPECIAL USZ <br />LLGAL UESC IIIPT ION OF PROPERTY (SHOW BELOW OH ATTACH <br />FOURCOPIESI ,y VARIANCE ij SHORLINE <br />LOT lf'� .3 BLOCK —OF 'J.tc 1✓�7 •L <br />// SE PA CHECK LIST REQUIRED <br />7-a 7 s L-t• YES <br />3::j NO <br />JOB ADDRESS <br />MECHANICAL <br />3 2 !.:: w c✓ d .-1 <br />PLUMBING _ <br />TYPE OF ENERGY <br />❑(. AS ❑ELF. C:. <br />' <br />NO. <br />- <br />TYPE OF EQUIPMENT _ _ _ <br />�S <br />_ FEE <br />_ _ <br />AIR COND. UNITS-H.P. EA. _ <br />i <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />REFRIGERATION UNITS H.P_EA. __ I <br />BAUH TAUS <br />CLOTHES WASHER <br />I <br />FORCED AIR CYST EMS O.T.V. MEA. <br />_ <br />DISH WASHERS <br />DHINKING FOUNTAINS <br />SPACE &_WALL HEATERS - B.T.U. <br />_^ <br />FLOCH DRAINS <br />1 <br />UNIT HEATERS B.T.U. <br />-�T-- <br />_ <br />KITCIIF.N SINKS & OISP. <br />I <br />.— -"-- <br />EVAPORATIVE COOLERS <br />6:.•E OINKS <br />ROOF DRAINS RAIN LEADERS <br />I <br />I <br />CLO TN ES DRYERS <br />1 <br />T <br />SHOWER BATHS <br />VENTILATION FAN <br />SERVICE SINKS <br />RANGE HOOD _ <br />'T— <br />I <br />SUMPS .. SEWAGE PUMP <br />AIR HANDLING UNIT_ C.F.M. <br />URINALS <br />( <br />_ <br />WATER CLOSESS <br />I <br />HEATER <br />WATER FIEATE115 ._ ELECTRIC <br />I <br />.._•—T- <br />_WATER <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />WASH BASINS <br />I <br />,.. _ <br />GAS. SYSTEM: NO OP OUTLLIS <br />•.. ------ <br />LAUNDRY TP.AYS <br />_ <br />• <br />_ <br />_- 'GUR TOTAL S. <br />_ .._.. ... I <br />PERMIT —S <br />r <br />I <br />'-'�-----�-- TOTALFEE,S--__I <br />SUB TOTAL <br />I <br />TjjjS YF.TR.11T OECOMES NUI . AND VOIU II W(1RK OH CONtiT RUC <br />PERMIT <br />S <br />TION AUTIIURiZED IS NOT COMMENCED WITHIN 170 UAY!:.OR IF <br />_ <br />TOTAL FEE <br />CONSTRUCTION OR WORK I!: GU11PI'NOED OR AOANOONHT FOR .1 <br />PERIOD OF 170 DAYS AT ANY IIMF AFTER WORK I!: COMhIFHCLD <br />WATER SERVICE SIZE BLDG. SUPPLY SIZE <br />1 IIEREnY CERTIFY THAT 1 HAVE HEAD AND E`(AMINLO THIS AP <br />VA:VAIiLIUACK <br />blHLLI LJ <br />HLAH YAHUSLTOACK <br />PLICATION AND KNOWTHE SAME TO HL TRUE ANO CORRECT. ALL <br />. <br />PROVISIONS OF LAWS AND OHOINANCES GOVERNING THIS TYPE <br />!:PECIFILO HEREF <br />OF WORK WILL BE COMPLIED WIT14 WHETHER'. <br />USL 'TUNE f <br />LUT AREA <br />VACANT SITk� <br />OR NOT. TIIE GnAN71NG OF A PAUTHORITY ERMIT ODES NUT PN ESVh1E TC <br />OR PROVISIONS OF <br />E: <br />• <br />❑YES I� 46 <br />GIVE <br />GULA INCEL <br />ANY OTHER STATEonLOCALLAWHLCONSTf1UCTIOn <br />OR THE PERFORMANCE OF CONSTRUCTION <br />TvVFOni CO HST. <br />OCCUPANCY GROUP <br />NO. OF OWE LUNG <br />. <br />N /Z- 3 -."'_ t <br />SIZE OF LOG. NO. OF STORIES MAK. OCC. LOAD <br />_ SIG NA ' f ONTRACT <br />1 -IIII: ZONE IIA!:k ML Ni /INk !:1'111N KI.L115 <br />REOUIHEU ' L.vN G N L CK NVMIILN <br />5 /J a ❑Yrs C N� <br />SPECIAL CONDITIONS:��,-- <br />SEPA REVIEW COMPLETE: OYES <br />contact planninq dept. <br />IIUILOINO — <br />—� <br />NO <br />PLUTImFJR <br />MI.CHANICAL <br />OTHER <br />errnpNPiue uu�aU llr <br />PF.NALTY_— <br />TOTAL <br />�ciL_Ei(ilL_ nrE ff <br />OR AUT/I�ENT <br />1L�IIl Cn 11. LCn I LL <br />E,/-., - (RECEIPT NO <br />VALUATION FEE <br />I <br />I <br />1 <br />1 <br />• 1 <br />SEC. 307 IId <br />1 <br />