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- CONSTRUCTION <br />.3��L <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNLR <br />MAILAUUKL" <br />ZIP PHONE <br />r is ovd <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />PHONE' LICE NSt N <br />GENLRAL OG NTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NU. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />--- <br />PERMIT <br />CLASS OF WORK <br />❑COMBINATION <br />❑ BUILDING ' ❑ PLUMBING ❑ MLCIIANICAL <br />❑NEW <br />❑ADDITION 0ALTE14A I ION REPAIR , <br />VALUATION OF WORK <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑':IVIMMINti Pool. <br />S �G <br />0 <br />DESCRIBE WORK <br />-CiI-P <br />PROPOSED USE <br />OTHER PERMITS OR APPROVALS <br />J� REZONE q SPECIAL USE <br />#VARIANCE L� SHORLINE <br />LEGAL Dk SCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES /',J {, 5-r — <br />I Fl-"%LOCK(1 ,OF Pit G II CYS I IA <br />LOT <br />SEPA CHECY..LIST REQUIRED <br />L-t YES <br />I:1 NO <br />JOB ADDRESS <br />cz G .- <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY ❑GA,) ❑ELEC. <br />_ _ TYPE OF EOUIPMEN7 --1 FEE <br />_t_... _. <br />NO. <br />AIR COND. UNITS -II, P. E0. <br />RLT RIDE RATION VN115 HP LA. —�—_ <br />_ � 1 <br />BOII ERS 11 v. EA. - -� - —_ •---^— 1 <br />---1�— <br />L_-- <br />FORCED AIR SY ST Eh1S B.T.V. MEA.DISH I <br />SPACE- & WALL HEATERS - P.T.U. I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />- — <br />RA 111 TUBS _ <br />5 <br />CIO THFS WASHER <br />I <br />WASHERS <br />DRINKING FOUNTAINS <br />FLOOH DRAINS <br />I <br />UNIT HEATERS ILT.U. <br />_ 1 <br />T <br />KIICHI,N SINKS 14 UISP. <br />I <br />BAR SINKS <br />1 <br />__ <br />EVAPORATIVE COOLENS <br />11001 DRAINS RAIN LEADERS <br />I <br />�1 <br />CLOTHES DRYERS <br />1 _ <br />�• - <br />SHOWER BATHS <br />VENTILATION FAN <br />J <br />SCHVICC SINKS <br />RANGE HOOD .ter-- <br />_ <br />SUMPS - SEWAGE PU%IP <br />'--- <br />AIR UNIT <br />URINALS--_C.LM. <br />I <br />_HANGUNG _•.___ <br />- <br />WAI E11 CLOSETS <br />I <br />_..._. <br />Wn TEH.HEAT____. ER . <br />ATER RLATEHS - ELECRIC <br />WT <br />--- <br />FAC. BUILT FIREPLACE B CHIMNEY 1 <br />WASH BASINS <br />LAUNDRY IHAYSGAS. <br />I <br />_ _ _ . .. _ : _ ....... <br />SYSTEM: NO OP OV7U.1S_ " <br />qTALS <br />ISUB <br />TOTAL <br />- <br />THIS PF11h11T BEC01.1LS N1111I. ANO VON) II WORK. IlR CO NSTRUC <br />PE_R_M_IT <br />5 <br />TION 4Uf11ORIZED IS NOT COMMINC(O WITHIN 120 DAYS. OR IF <br />_ <br />TOTAL FEE <br />S1 <br />CONSTRUCTION OR WORK I;: SU9PE NOEO O11 ARANOONED FOR A <br />PERIOD OF 170 DAYS AT ANY TIME AFTERWORK, IF:COMMENCLU. <br />HATER SERV:CE SIZE BLnG. <br />SUPPLY SIZE <br />I RERERY CERTIFY THAT I HAVE REnO ANT) EXAMINID THIS AP <br />1 ]L n 1 TBACK <br />IItAH YANU 5L itlACK <br />PLICATION AND KNOW TOL SAME TO RL TRUE ANO C(IRRI'. CT. ALL <br />PROVISIONS OF I. AWS AND 0110INANCES GOVERNING f11IS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER :,PF.C'r'Et) HEREIN <br />_ <br />USL ZUNI LUT ANLA <br />^— <br />VACANT SITE <br />OR NOT, THE RRAN7ING OF A PERMIT DOES NOT PRE VI.IE TO <br />GIVE AUTHORITY TO VIOLAfk OR CANCtL TIRE PROVISIONS OF <br />OYES ONO <br />ANY OTHER STATE OR LOCAL I.ANI REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION , <br />TYPE UT CONST. OCCUPANCY GROUP NO. OF OWE LUNG <br />F <br />UNITS <br />SIZE OF BLOC. NO. OF STORIES <br />MAX. OCC. LOAD <br />,! <br />ziYNav77 <br />SIGNATURE OF CUNTFIACTO OR/1UT11. nGE NT DATE <br />i•If/!Z(]Nt IIA::k MLNI <br />' <br />RLUUIl'HINKI.L II <br />RCUUIRFD <br />1'L.LN CIIL CK NUMIILII PLAN CALL"K FL( <br />OYES ONO <br />FEE RECEIPT NO <br />(PLCIAL CONDITIONS: <br />FEES VALUATION FEE _ <br />BUILDING <br />5EP.0 REVIEW COMPLETE: OYES ❑ NO <br />PLIIMnmi% f <br />_—•• <br />COn10C1 Plonnlnq dept. <br />MLCIIANICAL <br />I <br />• <br />OTHER 1 <br />T <br />TFIIC�lIU4 µLIRlU Y]. vlA4)L4l(aIU YY. <br />FUYIIUVIU UK AKI NY <br />PENALTY SEC. 3D0(Y) 1 <br />f l <br />TOTAL f <br />