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I.�+ —in� <br />v 11'4.S/ I lUli i�f�l <br />PEPI" IT•APP! ICAT10N <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />. `P moll nUurll:+> ZIY 1'11UIJL /1 _ <br />rnurvt <br />`\�r� �� _(ILL 'i.. �'� �"•t. _-I�"-v_,. .tiy�. ���a ,.! '7f z? <br />❑CO PAB It: AT ION <br />RIBUILDING ❑ PLUMRING ❑ MLCl/ANICAL <br />VALUATION OF WOnK <br />/ <br />S I '_�l� ,y l <br />PROPOSED USE <br />LLGAL DESCRIPTION OF PROPEflI T(SHOW Bi <br />FOUR E51 �� / _ <br />LOT BLOCK 0F_\L.3�./`-�YJ•(X.)c <br />ESS <br />P '1 <br />IL <br />❑NEW ❑ADDITION ❑ALTEIIAf1ON-•••-AEPAIR <br />❑DEMOLISH ❑FENCE ❑SIGN ❑':WIMMING POOL <br />OTHERPERMIIS ORAPPROVAIS <br />OR ATTACH Tj REZONE 1:1 SPECIAL USE <br />#VARIANCE ij Sr'ORLINE <br />SEPA CHECK LIST REQUIRED <br />I:' YES <br />7:1 NO <br />'MECHANICAL <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />NO. _ _ _ TYPE OF EQUIPMENT _- --FEE <br />AIR COND. UNITS-IJ.P. EA. S I <br />LA. <br />—i .- <br />REF RIGERATION UNI TS•1/P. + <br />-BOIL EIIS-�- <br />FORCED AIR SYSTEMS B.T.U. MEA. -��- <br />_ SPACE h WALL HEATERS •• B.T.U. _ <br />UNIT /IEATERS R.T.V. I <br />EVAPORATIVE COOLERS --r— <br />.._---_-__ _. 1 <br />CLO'f11ES DRYERS 1 <br />VENTILATION FAN —!-- <br />-_ NR //ANGLING UNIT <br />TIC 1 •. WATER .HEATEfl <br />-- FAC. BUILT FIREPLACE h CHIMNEY - <br />GAS. SYSTEM: NO OP OUTIf.t_5 <br />.....un IOrAl. ..S. <br />I <br />._.�- _— - TOTAL FEE S <br />y 1 <br />SU_p TOTAL <br />I <br />711j.S pEf1AVT BECOMES Nlll 1. AND V0111 11 WOIIK I114 CONSTRUC <br />PERMIT $1 <br />_ <br />TION AUTl1OnIZEO IS NOT CTIMMLNC(D WITHIN In DAY%OR 11 <br />TOTAL FEE $1 <br />CUNSTIIUCrION OR %VOFIK IS SU;:I'F NOED 011 ARANDONEO FOR <br />NATFF SERVICE SIZE <br />SLOG. SUPPLY SIZE <br />PEnIOD OP 170 DAYS AT ANY flME AFTE11 WOFIK I!:C(IMMENCED <br />iD- A <br />1 <br />•�"� <br />I IIE FIERY CERTIFY THAT I IIAVL PILAU AND EYAMINIO THIS AP <br />.11 L n <br />UACK <br />NtAH YAHU St 7UACK <br />PL ICATION AND KNOW THE SAME TO Pik TIIL1E AND COIIRI'CT. ALI <br />PnOVISIONS OF tAWS AND OfiDINANCES GOVEIINING 11115 TYPI <br />OF WOIIK WILL BE COMPLIED WITH WIICT11EF11:PECIFIEII HERFI• <br />Wl lUNk <br />LUl AHLA <br />VACANT SITk <br />OR NOT, TILE TinAN iING OF A PERMIT DOES NOT PRESUME TC <br />GIVE AUTIIORITY TO VIOLATk Oil CANCLL TIIE PROVISIONS Of <br />OYES ONO <br />ANY DINER STATE Oil LOCAL LAW lit(:ULATINU CONSTRUCTIOP <br />TYPE OFF CONST• <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />OR THL PERFORMANCE OF CONSTRUCTION. ' <br />UNITS <br />SIZE OF 6-LDG. <br />•� /.T <br />NO. OF STORIES <br />VAX. BCC. LOAD <br />(. C <br />X <br />SIONATUf1E OF CUNT RACT01t OR AUTI/. AGENT DATE <br />I lilt 2l]N! <br />IM:a MI NT <br />Illlt .'l•IIINKI LItS <br />NEOUIHEll �'LANCIILCK <br />❑YES ONO <br />NUMIILH <br />PLAN CIIL CI, I LL <br />IFLC <br />RECEIPT NO <br />SPLCIAL CONDITIONS, <br />FEES - <br />VALUATION <br />FEE <br />----- —_—`- <br />- <br />- <br />-��-- IIUILOING 4 -- ---� <br />• <br />SEPA REVIEW COMPLETE: OYES ❑ NO Pt IPMIIINCI � <br />COMBO PlOnnlnq (IOj1I. MECHANICAL'-�-- • 1 <br />OTHER <br />1 <br />"LICMIUNALurHuvY •- rLA41 LHllIILU Yr - MPrgvID uK u.1UlML1. YY PENALTY SIC 3031.1 I <br />1 TOTAL j <br />f <br />1 <br />