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- CONISTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNtN MAIL f.UU,iLLL ZIP /.�isO ,PRUNE <br />ARCNITECT Ufi SIGNER AIL ADDHE S PHONE LICt N5E NU <br />GENERALCONTRACTOR MAIL ADDRESS PHONE LICENSE NU. <br />f - '-.4 <br />MET:NANIC AL COXTi RACTUfi `) MAIL ADDRESS PHONE LICENSE NO. -.? j <br />PLUMBING CO TRACTOR MAILADDRESS 77/"t!o LICENSE NO. <br />PERMIT <br />CLASS OF WORK <br />MCON181NATION <br />Ly BUILDING []PLUMBING ❑MECHANICAL <br />CR NEW []ADDITION❑ALTERATION ❑HEPAilt <br />`9 <br />VAIUATION OF WORK <br />_ <br />❑DEMOLISH []FENCE ❑SIGN ❑SWIMMING POOL <br />s �O <br />41 <br />DESCRIBE ' <br />PROPOSED USE L / <br />OTHER PERMITS OR APPROVAIS <br />,A.)e �J /`-Y o IL %- c <br />jI RE ZONE $j SPECIAL USE - <br />VARIANCE .Lj SHORLINE <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />FOURCOPIESI <br />LOT LY BLOCK. IL OF -5 CL 4 <br />SEPA CHECK LIST REQUIRED <br />i` 7' <br />= YES <br />]� NO <br />JOB ADDRESS <br />ZD <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY ❑(: A.: -- FLF.C. <br />TYPE OF EOUIPMENT FEE <br />NO. <br />AIR CO ND. VNITS-/1.P. EA. S I <br />REFRIGERATIDNuNI TS 1_P-End__ j�_�— <br />OOII ERS H.P. EA. <br />FORCED AIR SYSTEMS B.T.U. MEA. I �— <br />--.' <br />---" ------- '-- '--T <br />S ACF. 6 WALL HEATERS H.T.U.- , <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />HA1H MEIN <br />5 �- G�. <br />--- <br />— <br />-- <br />CLOTHES WASHER <br />DISH WASHEIIS <br />�` C) <br />DF41NKING FOUNTAINS <br />i <br />FI OOH DRAINS <br />1 <br />UNIT HEATERS A.T.U. _. <br />KITCHEN SINKS & OISP. <br />i -[;(j <br />IIAIt SINKS <br />I <br />EVAPORATIVE COOL_EH_S <br />FIOOF OHAINS RAIN LEADERS <br />i <br />! <br />CLOTHES DRYE RS <br />•'j0 <br />( <br />SHOWER BATHS <br />VENTILATION FAN <br />SERVICE SINKS <br />RANGE HOOD <br />SUMPS - SEWAGE PUMP <br />__. <br />AIH //A LADLING UNIT C.F.M. <br />.______._._.._ <br />WATER <br />ITRINALS <br />, <br />• <br />_WATFH CLn,CTS <br />�' >(. <br />4 <br />_WAILF1 HEATERS - ELECTRIC <br />_ _ <br />. --- <br />_HEATER.- <br />FAC. BUILT FLIEPLACE & CHIMNEY_ _ <br />GAS. SYSTEM: NO OP OUTLE. IS <br />_-- ..--SLID IOTA.... S. <br />_ I <br />T� <br />' <br />WASH BASINS <br />LAUNDRY TRAYS <br />PERMIT ._S <br />TOTAL FEE <br />TI/IS PLTIf.11T UECO.MES N[II L AND VOID II W011K 11H CONSTRUC <br />1ION AUTilORIZED IS NOT COMMLNCLD WITHIN 1?0 DAYS, OR IF <br />CONSinUCTION OR WOFIK qi SUSPE LADED OR AIIANDONEO FOR A <br />PERIOD OF 170 DAYS AT ANY f IMf AF TEII WOTIK I!1 COMMENCED. <br />SUn TOTAL <br />rU <br />PERMIT S <br />-✓ <br />_ <br />TOTAL FEE <br />VATER SERVICE SIZE BLDG. SUPPLY SIZE <br />w�.•m3 <br />111L Rk ItY CERTIFY THAT 1 11AVE IILAD AND EXAM INLO TII15 AP- <br />PLICATION AND KNOW THE SAME TO III, THUS ANO COliltt'CT. ALL <br />R aL K <br />1 BACK <br />HEAR VAHU 5t TBACK <br />PROVISIONS OF LAWS AND ORDINANCES GOVLRNING 11,15 TYPE <br />USE TUNE - <br />�(/ <br />LOT AHLA <br />VACANT SITE <br />OF WORK WILL BE COMPLIED WITH WIILTHEn SPECIFUD HEnE1V <br />OR NOT. TIIE GRAN7ING OF A PERMIT DOES NOT PRESUME TOI <br />GIVE AUT11DI11TY TO VIOLATE OR CANCEL THE PROVISIONS Of <br />^ (/ <br />LIVES ❑NO <br />ANY 01HER STATE Oil LOCAL LAW IILGULATING CONSTIIUCTION <br />Oil Tllt PERFORMANCE OF CONST HUCTION. <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />V i 1 <br />I <br />/ <br />SIZE OF BLDG. <br />NO. O0 STORIES <br />MAX. OCC. LOAD <br />�lG> J <br />RACTOR OH ALIT//. AG ENT ATE <br />SIGNATJI EOF CONT <br />2(iNk <br />IIAliF ML NT <br />ntoIIHA !il'HINK LL115 <br />REOUIHLU <br />LAN GILCK NUMBIT/ <br />PLAN CiILCK FLL <br />❑YLS LINO <br />, <br />FEES <br />ILE IIECEIPT NO. <br />VALUATION FEE <br />iPLC1AL' CONDI TIONS: <br />IIUILDING <br />S ���� t 400 <br />II J <br />Y/, <br />• <br />,Gll <br />SEPA REVIEW COMPLET DYES I] NO <br />PLIIMIIINO <br />contact pIpnninq dept. <br />MECIIANICAt <br />OTIIER <br />1 <br />PENALTY <br />SEC. 303(0 <br />1 <br />H11(AININ�KIFIIU�Y <br />IANi[NIU, IFY <br />UFNUVIUONWU.KI YY <br />-- <br />� ;1 1 (1� <br />TOTAL <br />t <br />I <br />