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- CONSTRUCTION �'""'' '�`� _ <br />�7<r <i�r��i <. <br />PERMIT APPLICATION � �y � � � �a <br />. ,�1�,��_�� . <br />COMBINATION • BUILDING • MECHANICAL • PIUMBING <br />MAIL AUUNlSS ZIP YNUN! <br />=t✓��n �c r_ %s,� CS��� � �I,z '>` ��':, <br />a C.J.-� f C� <br />-�i .�c-w�-�� �y. <br />VERMIT '---�- CLASiOFWOHK • -��—' - <br />❑ COMOINATION <br />p[iUILDING ❑ PLUMOING � MICNANICAL <br />�NEW ❑4DOITION ❑nLTEflnflt)N ❑HCI�n111 <br />VALUATIONOf WORK —`."'-""""------ <br />s ' � ��'� ❑OEMOlISH ❑FENCE ❑SIGN ❑::WIMMWti P(IOL <br />C U � (J <br />LlGAL D6.^.Cf11VT1UN OF YRO <br />FOUR CUPIl51 �� <br />LOT � BLOCKC" OF <br />ADDRC55 <br />� <br />PLUMBING <br />� OTHER PERMITS OR APPROVAlS <br />ISHOW BELnW UR ATTACH '� RE ZONE � SPECIAL USE <br />��- - ,�.i �. VARIANCE L� 51-:ORUNE <br />SEPA CHECK LIST REOUIRED <br />LL' YES <br />I'� NO ' <br />f .✓! <br />wnren ser:v�ce sizr: <br />�-aTitirs�.'Q� <br />U:il ZUNL LUl ANLA <br />TVVE OF CONST. OCCUPANI <br />SIZE OF OLOG. NO. OF STI <br />1111!!c)NI' "-- 11/11:lMLNi <br />SPCCIAI CONDITIUNS: <br />ULDG. SUPPLY SIZf <br />'MECHANICAL <br />TVPE OF ENEHGY <br />C7r,ns ❑e�ec. <br />• lNO. TVPE OF EUUIPMENT � FEE <br />—.__ ".___._"_ . ....__"_t_.._'_"'___ <br />AIHCUNO.VNIT.^.-H.Y,EA. �S I <br />..�.. ..._.. ..._'_" _"_." . '___.. ...'___+' ...___r— <br />/ RkfRIGERATIONUNIfti RP.EA. . <br />" "_ _' _""_'_" ' __'" l <br />�OIlEf1 H.P.EA. � <br />FORCED AIR 5�57EM'� I1.7.V MEl1. �— <br />. �_. ._..'_"_. "__. .. _..�_"' _L'_ <br />� SPACE h WALL HEATENS H.t.11. ��—��- <br />4CANTtL:I <br />❑YEi ❑NO <br />fl'111NK1.1 Ilti <br />IHEU ' <br />f� ❑NO / <br />�� <br />. ___.—_FEES —.."..' <br />— HUILUINf. _— ' <br />I.. . "__ _' <br />.� <br />Ml11MI11N1: <br />MC CI IANII'Al •._..••• _•. <br />OT/IEH <br />�r ��. PENAITV <br />TOTAL i <br />UNIT 11EnTEPS B.T.U. 1 <br />� [VI�VOHATIVECOOLEHS �--T— <br />. _..'_'___�"" "' 1 <br />CIUfH[SDRVERS � <br />VENTILATION FAN -T- <br />___ _ l <br />RANGEIIOOD 1 <br />_ _"_"_'-"___"'___.. <br />l�IH 11ANDLINC UNIT C.f.M. T� <br />_... ._"_"_'_'_.._'_'""' . ..... ..."."...... __...""`� <br />I <br />. .. I WATER _IIEATER'.•. . . .- _ '_�'-'�— <br />}I- j` FAC BUILT FIHEPLACC W C���AINlV I � <br />/--I CAS SYSTEM NO OV OUTLl.15 — -- ^- ___r-- <br />I � _ ' . " 1'__ <br />�Ufl TOML 5..• ... � <br />- — — —. . � <br />S�"_"_'___"'_._ _"_FEI7MIf .. _S __._'1-_� <br />T[1TAl. f EE 5 I <br />7111^ PF.11R11T UECOMES NUI l ANI? Vc)IU II WUIIY, ON CONSTf1UC <br />TION AUf110HIZED I$ NOT (:OM41tNCEU WIT111N 1?0 UAv!:.ON IF <br />CUNSTIIVCfION Ofl NOIIK I!i SU91`I:Np[D 011 Af1ANOpUEO Fpq A <br />P[f110D OI' 170 OAVS AT ANY IIMF AF TF:II\VOIiK I:: Co�d1dF NCEU. <br />1 IIC Hlliv CERTIf V TIIM I nAVE HLAf> 4ND !:Y/�h11N! D illl: nP <br />PLICATION AND Y.NO�V T11! SANE T(7116 TRUC ANU COIi11FCL l�lL <br />PBf1Vl,^.IONS OF I.AIVS ANII ONOINANCES fUVEiiN�NG 11115 TYPE <br />OF WOItK W1Ll BE CO�dI'I.IF.D WII11 WRt1nE11 :�VECIPIlO ��[fiEIN <br />Ofi NOT, iHF (if1AN:ING �1F A PF.fihllr ppE!; NOT PHE$V\•.E TC <br />GWL' AV111p(IiTY TO VIOLA(E OH Cl�NCtl fRL 1'NUVItiiONS OF'. <br />ANY 07Hf.R STME OR LOCAL LAW NL(:VLATWC. CpM:iHVCTION <br />Ofl iNE CCHFORMANCE Of CONSTHUC710N. , <br />r � � � <br />/ <br />�; ; .��� <br />SEPA REV(E\V COMPLETE � ❑YES ❑ NO <br />confacl Planninq depf. <br />'1_.K_�_. <br />I l:l' <br />/��. (o <br />VAlUAT10N � <br />C 7 fi� <br />DATE <br />w�e�w <br />_CK 1 L! <br />11[CEIPT N(+ <br />Ff.E <br />:�,.5�a.._.._ �y�o a <br />_ r_._, <br />� <br />I <br />. i <br />�._ <br />� <br />SEC.J071e1 <br />