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� - CQI�STRUCTIOM <br /> PERMIT APPLICATIQN � <br /> COMBINATION • BUILDING • MECHANICAL • PLUMBING <br /> OWNkH MAILAUDNLSS ZIY YHUNE <br /> ��o�cF:�.��s .�ti-u n ��2�.� 9�.�c,3 ' .��a -c,�,� <br /> AR f11TECT Ufl UE51(:NER MAII AUGHkSS PNONE UGENSE NV <br /> GENLRALCUNTRf�CTOH MAlLA00RE55 VMONE LICENSENV. <br /> � �c J �h� O/�"_" .L'✓G- � , � X a��v % .-�.i 4'C�C'�7 C.`��-Gv-Ti�'- r'C/_3� <br /> N.EI'HANICAL CUNTRACTOR MAIt ADDRE55 � PHONE �ICFNSE NO. <br /> ,��L�_(.?i� /�P/.aT/NG- ' . <br /> Pl'JMUING CONTHACTOR MAIL ADDRESS PHONE LICEN�E NO. <br /> JC.L2 //L'� ^�! ry/1 (r� . <br /> MGRMIT C1A550F WORK • �— <br /> ❑/COMBINATION <br /> �"OUII[)ING ❑GLUMflING �MtC1/ANICAL <br /> �NEW ❑AOOITIUN ❑ALTEfil�flqN ❑11UV.in <br /> VAIUATION OF WORK —. .-..-._.. .'-' . <br /> S �S OOn ��-��-% Ci'[;�/ �,J ❑DFMOLISH ❑f ENCE ❑SIGN ❑':WIMMIKt: PUOL <br /> D:i5CRI0E��URK ' � <br /> � • <br /> L IU` " P , �Nt'!L <br /> 7ROPOSEO USE OTHER PERMITS UR APPROVAlS <br /> ��'��<<�-- � RE ZONE � SPECIAL USE <br /> LLGAL 11f�SCfiIPT10N OF YROPkRT\ jy'HOW OELOV+Ufl ATTACl/ <br /> FOURCUPIESI #VARIANCC � SNORLINF. - <br /> LOT BLOCK_OF <br /> SEPA CNECK LIST REQUIRED <br /> � - � ]�' YES <br /> . i-- — �I NO <br /> -1_�!_L <br /> �on nooness <br /> '�� ,—� u �MECHANICAL <br /> PLUMBING . TYNE OF [NEHGV �-1 <br /> uf:A} ❑FLF.C. <br /> . NO. TYPE OF E�UIPMENT � FEE <br /> AIFCONp.VNI7S-11.1'. EA. �5 . iV � <br /> NO. TYPE OF F�%.'URE OR ITEM FEE RkffiIGERl1TION VN�fS ��N. Ln� -� - <br /> IlA�NT11U5 S T�:%t -" OOIIERti�1/P. EA. -�""�"-""-'--_.• -^--"-- <br /> I CI.UiHFS \7AS�IFN • '�,i.i , "- ' ' - '-� "- I <br /> Ui.`•H YIAtiHENS ���;,�� ,_ FU�CED AIfi.5Y5TEMS H.LV_ MEA_ �. _.-Q,T-(`_ <br /> Uli NKING FOUVTAINS � .-_ � <br /> � 1 lOH UIIAIN5 � ^ SVACE & WALL MEAIF:NS - fl.T.V. "__'t— <br /> ��YIIf:111�.N ::IHKSt I]151'. �.j.%� UN�TnFATERS N.T.V. _____ ..__.�__ <br /> IIAII 'i'NI:S � EVAPORqIIVCCUOLEHS <br /> IUQF I1i141N5 RAIN L[AUGHS ' -_T— _1 CIUt�ICS D�t�'E1i5-""-�-"�'-"'-' --"- =.,1')f, <br /> :iNQIVEII ��A�HS �_� r� � �'ENTIInTIONfqN-�-- - �,,T�/� <br /> SCHVICF ;;INK$ `� RANGE HOOU _� '% If1(� <br /> 5UM1 S �� tiEIVAGh PUMP � � - '-'-- — '-�''--�-� <br /> !JH IIANDLINC VNIT � f M. <br /> URINALti � _. . ._ . .. . . .." '- � .__..._1_._..� <br /> ' 1VA1FRClOtiCTS ��� .� . � <br /> WATkN HIATEq . . .._ . . - . _•'�T--"' <br /> ! WATL� HFl�TEHti - ELECI_RIC �l^: - ..4-��. <br /> VJASM BASIN:i • ,�.�� FAC. �VIIT FIREPIACE K C��IhINhY I I <br /> IAUkURV Tf1AVS OAS. SVSTEM: 610 ON OU7LLI5�_-"...._I -.. � "-1'-- <br /> • __ ._ i " ___..""'"'". ... ..,iUIiTO(AL 5 ��.fif--__ <br /> -- � '- �--"-" -"' VERMII 5 �. <br /> __ ' _ SUQTOTAL :`�i '- '._'_.'____"'._ ".'_TOMIFkf' S "' _'-iiti('_• _' <br /> PERMIT § � t111S i'(:iUAiT UECO�dES N1I11. nNfi�VOIU U WU111: ���t Ci]NSTIiUC <br /> TOTAL FEE '-- TIUN /�U�I�OqIZED IS NO1 Cp:dAllN[(D 14rt1UN 1?0 U.1V.^., Oq IP <br /> _ CON.iflUf.f10N Of1 1VO11K Ill 5V`:�`fNO[O nn nI1nNDOui�O ipH A <br /> NATER SBFiVICE S11F._=_ J BLOG.SUPPI.V 517.E�_ N�-fiIOU OP I:OOAYS f�T ANV �iMi- A� r[nwonK �!:C�wn�kNCEU. <br /> S�- �� � ..l i (.h IUACK HLANYANUS�lIOAC!� 1 11[R60V CCIl11FY TIIA1 I IIAVE IILAU AND F�fA1,�iN1 f) t11Ci /�P <br /> . PLICI�TIOA AND KNOIV TIIL $AAtE i011h TI:VE nNU COIiNf�.CL M L <br /> -� � ' .. - ' PfiOVI!:IUNS OF I.A1V5 ANU DIInINANCF.ti GOVCR\iKG tiUS TVPt <br /> � ' 1 �� {r � --�l��� � . OF Y:OItK WILL 6[ COMPLIIU Wi1M N'NETHEf1 ::PfCIF1lL` IIEfiCIN <br /> ) ' <br /> V:il IUNL � -LO7 ANLA �VACANT SI:L �� OR NOT, THh 6fiAN71NG Of 4 �'ER411T OOES NOT PRE:VME 10 <br /> _.1� ' C:IV[ AUiIlOR1TY TO VIOLAft UII CANChI T11E N�UV�SiONS Uf <br /> :�'1" OYF.S ❑NU ANV qT11@ti tiTt�7! OIl I.00AI I.A1v IIL.:VL/�TWii CONl:T11UCTION <br /> TYPE Of CONST. UCl'VYl.NCV(i110VP NU.OF DWhLUN(i Of1711k Y4HFOHMANCE Oi CONSTHVC110N , <br /> UNIT9 I � <br /> S12C Uf OLOG. NO.OF SiOfil@5 MA%.OCC. lOAO "/�/f/�� `/ <br /> .�:' Y� �' �l �L' X/L. .4/.�/" =_ .?�'�'�_? <br /> _ $lGaATURlO( NTRACTOftOHAUTl1.AillNT DAT[ <br /> IIIII:Zt)NF � -� IIA7:LMLtiT 4�IIIl•.�1'l1iNKl.l11. <br /> � qlOUINfU - PLnNCMLCK NVAti1lH YIAtV CIIICY, 1 LL <br /> �'� ' �.�f:. ._ ❑YIS C'�NO <br /> [ � {4l' IICCEIPi Nf� <br /> S�LCIAL CONOITIONS: 7 � ' , � I -7 <br /> ..."_ �� / _D/=�'.J�� , ' ' �. _.` .7� .� / �' <br /> _ FEES VALUATION � F[E <br /> _,__.___' ."_.r_"_ • <br /> ._.r.___�.._�_._�._._ -�� 1 <br /> _..._"'—_ __ '___.L. <br /> _'.� __. ._ i OUILOIN6 _ �.-._� "'_��_' _(~ " "_'/"'r"'_ f <br /> � PIUMflINI: <br /> SEPA REV(EW COMPLETE � ❑YES ❑ NO � � �(.' :.:� <br /> conlatt planninq depl. nnic�inNicni �_.._ .._ . . . I(-{ ;�L;.. <br /> OTUCq I <br /> I <br /> ' __' "_'_T_ <br /> AMIIIAIIUN�ILViIUbY IIAM1>lNIN1U�� AMRJVIp7pNqSU�N[lYY ' y[N4LTV $CC �O7I�I � <br /> • • .__ ._�.��. �� �... ._...._...�.� . _.. . ..�.�._s•��.��. I <br /> __ ._. _ . ...' _ __' . _.'... ..._..—.''_ "'_�_'_—__.. TOTAL � . '�w...... .. <br />