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_ - , - <br /> - co�-r��c-�Ec� �� /z� �r -. <br /> PER�v11T f�►PPI�lC,��I�N 3�� <br /> COMBINATION • BUILDING • MECHAN�CAL • PLU(vBING <br /> OWNkN MAILAUUHLSS� [Iv Y11UN! � <br /> ����r�.rr(� �i�LL�✓o M �.ri. ��n.L&�� �r3 frr�vi �S�i - L <br /> CHI 1 UH DESIGNER MAII AD HE55 �NONk LICkNSk NV <br /> 6ENERALCONTRACTOR MAILADDNE55 �HONE � IICENSE NU. <br /> MECNANICALCONTqACTOR MAILAODNE55 IHONE IICEN5EN0. <br /> ►LUMtlINGCONTRACTOR MAILADDRE55 �MONE UCENSENU. <br /> ►ERMIT CLASSOF WORK • � , <br /> Q�yCOMlIN�1TION <br /> puU1LDING ❑PLUMBING �MECMANICAL <br /> ❑NEW ❑ADDITIUN ❑ALIENAf�UN Ci'Nlt <br /> VALUA�IONOF WORK y <br /> f � [1.uU ❑OEMOlISM ❑iENCE ❑SiGN ❑':WIMMIN(: t•(lOL <br /> OESCPIOE WONK ' <br /> ►RO�OSED USE OTHER PERMITS OR APPROVAIS ,. <br /> � �( RE ZONE � SPE�IAL USE ', <br /> `l6AL OkSCRIPTION OF YRO�kNTY ISNOW BELOW OR ATTA�N ' <br /> FOYRtCJO�/IESI C �� �$VARIANCE � SF'.ORLINE � <br /> LOT J.<��IOCK�L OF3c=�.4C A:V. � ' <br /> SEPA CHECK UST REQUIRED � <br /> I� YES <br /> J� NO ' ', <br /> ! �os woon►ss <br /> r � MECHANICA� <br /> � PLUM8ING TY/E OF ENENG� Ut:nL' ❑ELF.C. <br /> � . . NO. TYPE OF E�UIPMENT �_ _ fEE <br /> +� � AINCOND.UNITS-�6v. FA._. _ • _�� <br /> NO. TYPE OF FIXTURE OR ITEM FEE RkfA�GERAT�ON UN�fS ��V En. ^ _ <br /> IMIM IUUS OOIL[RS II,P. kA. ' '- �_�_�� <br /> � CIOTNES VMSHhN � • FONCED A�N SVSTEMS O.T.V.ME/�. <br /> � <br /> i UISH VIASMEIIS � � "-"-� '-"' "`-- �-� <br /> OHINKING FOUNTAIN5 � ' - ' '--" "-"-" ---- '- �� <br /> FI.00H O��n�NS � S/ACE 6 WALL MEATERS �� P.7.U. � <br /> KIiUHtN tilNKS G llISP. � UN�T 11EATERS FI.T.V T_ <br /> , d IIAR S�NKS � EVnPOHATIVE COOLEHS _,�__� �� <br /> t'� <br /> IIpOF DNAINS F�AIN IEAUERS CLOT��ESDP�EnS __��_ � <br /> SNOR'FN OATHS VENTIInTtON FAN � , <br /> � SB�IVICE S�NK$ qANGE NO00 � <br /> SUMPS - 5E1YA(iE PUMP AIR MANDLIN4 VNIi C.f.M. T-• � <br /> � � URINAlS '_ _""'-__'-._. _ ."'. "'_' __ _'.__' - <br /> WqTEII CLOSLTS � � <br /> , . . . _ __.._'_'. ._... . "' . . . _ _...._. ..._ �.._r�_ <br /> . WATER 11EAlEi1S - EIECTRIC � .._ wnTER NEATEn . _ . . ._ . _. _»y,.'__ <br /> WASM BASINS ' � fAC. BUIIT fIREP1.ACE b CMIAINEY I <br /> -. LAUNORY Tf1AVS tlA5 SYSTEM: NO OP OUTU.15 � T � <br /> • . � —_ '_'_" ... ^�UO TQML 5 �1-- <br /> � _ _ __ � '__'.__"�ERMii. S T_ <br /> � _.'___. ___ _ J . <br /> SUA TOTAL . _ T(1TAl FEE S 1 <br /> _� _ . <br /> 71115 VF.f1M1T U@COMES NU�I. ANO VOIU 11 WUI�K OH CO\S�RI'C <br /> iERMiT S TION nUf11pR1YEb IS N07 f.bMMtNC[O WITIUIJ t?0 U.�vS, pq iF <br /> TOTAL FEE [UNSTIIUC�ION OII wOnK IS SU:t�I'NDED O�i AfIhNOO�ED FOR A <br /> WAT[R SF.RVICE SI2F. BLDG.SUPPLV $IZF P�n10D OF 710 OAYS AT nNY flMk A!TEfi WOf�K IS C[�A�6�kNClO. <br /> �I�FVTS )R'Sc�T�A R�iLCT� � ACK HbAH TAHUSf TBACK � ���"f�v CEfiTIFY fNAt I 11AVE ncnn nan [rn�.nNi o r��is n•� <br /> : PUCATION 4NO KNOW THE 5A�1E TO Ilk TfiVF. ANtl COR11(CT. All <br /> . Pf10VI510NS OF LAWS AND qi{OINANCES GOVEfINING 1N!5 T\'PE� <br /> OF WOHK WILL OE C0�7PLIED Wlfl/ N'NlTnEH 1:PCC�F1lU MEf1E:41 <br /> {1liL 7lfNl �� LUl A11LA �� VACANf Slil-�- OR NOT, THF G�/�N71NG Of A PEHMIT DOES NOT PpESV!aE TOI <br /> ' CIVE I1UTlIURITY TO V�OLAfE UA CANCkL THE 1'NUVi510N5 Of <br /> ' ❑YF.S ❑ND pryY O�UIR StATE Oii IOCAL lnW IIE(iVl4TIN(i CONtiT11UCT10N <br /> �YPE OF CONST. OCCUPANCY�:.OUI' NO.O! OV.'tlUN6 OR TNk►EqFORMANCE Of CONSTRUC710N. <br /> uHrts ' <br /> 12�f:OF OIDG. ' NO.OF 570HIE5 MAK,OCC•lOAO <br /> X �,�..-�-- ..�L=ra./ <br /> fINLZONk IM17kMlNT IIH�tiI'IiIHKLl115 $IGN4TUf�0 CONtRACTOf10Rl�Ul/1.AGCNT OATL <br /> PfUU1RfU I LAN l'NtCK fJUMULI/ YIAIV O�ICY. 1 L� <br /> ❑Y[S ❑NO IkC IICCEIPT N(1 . <br /> tIkC1Al CONDITIONS: � <br /> . .__._.....�.�_.�.... .. . ... . . . . .. . ... ..... . <br /> FEES VAlUAT10Y FEE <br /> _ _---'— "_"'T_ <br /> -�_ �__�_—. 1 <br /> '"��'�.� BUIID�NG � f +— � <br /> I '__ .....��_"'�."' �"_'� .h�.r <br /> SEPA RE\'IEW COMPIETE � DYES CI N—O �"'Mn�N�i .�___ ._ � <br /> � <br /> tontotl plann�na dept. w:cennNicni • . .. i-_ . <br /> — . . � <br /> � OTNER � <br /> '.�.'_l_ <br />