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CONSTRUCT ON <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL Y PLUMBING <br />OW�NLR ,� <br />;yl11 <br />MAIl{�j UDHLS" <br />R?, <br />ZIP PHONE <br />_ }1/0 A. .�.7V 1N_12 <br />I.(j. <br />ARCHITECT OR DESIGNER �i <br />MAIL ADDRESS <br />PHONE LICENSE NO <br />-NO. <br />G_ENLRAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE <br />MECHANICALCONTRACTOR <br />MAIL DDRES�q <br />S///7 <br />PHONE LICENSE NO. <br />% <br />C <br />Y__• <br />PLUMBING' ON ACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />VERMIT <br />CLASS OF WORK <br />' <br />❑COMBIII ATION <br />BUILDING PLUMBING [:)MLCHANICAL <br />(T+I NEW <br />f+� <br />❑ADDITION ❑ALTLFIA(If)N- ❑REI'AI(1 <br />VV ALVATION OF WORK <br />[I DEMOLISH <br />_- <br />❑FENCE ❑SIGN ❑I;WIMMING POOL <br />S <br />_ _ <br />DESCRIBE WORK <br />! <br />PROPOSjA15t) <br />OTHER PERMITS APPROVAIS , <br />_OR <br />RE ZONE f SPECIAL USE J� <br />IIL�''� <br />SF'ORLINE f <br />LLGAL DLSCFIIPTION OF PROPLRTY ISHOW BELOW R ATTAC <br />Fouq,q,5�•rl��/ `I.l <br />l� ���vIANCE <br />1T FILOCK_OF_�%Il <br />LOT-"- <br />SE PA CHECK LIST REQUIRED <br />tT YES <br />N NO I <br />/� L <br />JOB ADDRESS n <br />�vP <br />MECHANICAL <br />rrane� <br />— <br />PLUMBING <br />TYPE <br />OF =NLnGY <br />El I, As ELF C. <br />TYPE OF EGUIPMENT _ _ _ FEE <br />P10. <br />_ _ _ <br />Al TO COND. UNITS-H.P. EA. S I <br />RLTnmERnTiDN vw rs <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />S <br />.__.. <br />ItA)II III BS <br />..__. <br />_ _..__ ..___—_ <br />BOILEnS R.P. EA. 1 <br />FORCED AIR SYSTEMS E1.T.U. MEA.- <br />----" _—"-- --- —_ I <br />SPACE & WALL HEATERS - R.T.U. 1 <br />CIO TH ES TVA 511 F.H <br />' 1 <br />11 WASHERS <br />DRINKING FUUNTAINS <br />I <br />F I,OOR DHAINS <br />1 <br />-- <br />-- -- <br />UNIT HEATERS B.T.U. <br />KIICHFN SINKS & DISP — <br />1—_ <br />BAR SINKS <br />I <br />EVAPORATIVE COOLERS <br />I IUOF DRAINS RAIN LEAUEIIS _ <br />1 <br />CLOTHES ORYEn1 <br />4- <br />SHOWER BATHS - <br />VENTILATION FAN I <br />.'iE iI VICF SINKS <br />__ <br />RANGE HOOD 4- r <br />SUMPS- SE WAGE PIJAtr <br />— <br />_- •____ <br />AIR HANDLING UNIT C.F.M. T— <br />UIIINALS <br />i <br />_ <br />WATER CLOSETS <br />I WATER 11LATEIIS ELCCTf IC <br />'� I' <br />-Wn TE_R HEATER <br />-- _ _ - --->•---- _ .-. .. <br />1VA!iM BASINS � <br />I-- <br />FAG. BUILT FIREPLACE t4 CHIMNEY _ I _ <br />-- <br />-- T <br />LAUNURY TRAYS <br />- <br />_ <br />GAS. SYSTEM NO OP OUTLLIS , <br />— - -- <br />TOTAL. FEE <br />SUB TOTAL <br />/1 <br />Nl-' <br />9 i <br />'- '" " - --� •� <br />71/11 PF. LIMIT Pi'COM ES Nl1.I 1. AND VOID II WUItY. OH (:(INSTn VC <br />PERMIT <br />5 _ <br />TION AUTIIURILED IS NOT COMMLNCED WITIIIN 170 DAYS. OR :F <br />_ <br />TOTAL FEE <br />CONSTRICTION On WORK IS SUSI`I'NDF.D Oil ABANDONED FOR A <br />_ <br />WATER SPRVICE SIZE R' <br />_ <br />SUPPLY SIZE_ <br />PLnIOD oP 1:0 DAYS AT ANY TIME Ilk TER NIOnK 11: COMMENCED. <br />_BLOC,. <br />RLIIY CC THAT I IIAVL READ AND EKAM INEn AP <br />PHIAL <br />�F , . .c A •ills 5L BACK <br />RLAH YA HOSEtI <br />RI D KNOW Sr\Mk TD ILLS COIL .cr. ALL <br />PUCT ION AND KNOW <br />C.ON Ci <br />(/(� <br />�-- <br />AN1 GO L II 7141S <br />OF WOn KNS OF 1E C AND OI WIT14 NCF.S COVERN:NG 11/15 TYPE <br />OF 1NOT, WILL BE COMPLIED CIFILD INI <br />THEIIDOES <br />A <br />VSL Z[INL LU7 AIILA <br />VACANT SITk <br />PE MIT NO ME TO <br />GI NOT, /IIk ITY T 41VI OF APE OMIT DOET NOT O ESI N TO <br />GIVE /1UTI1 TO VIOLATE ON CANCLL TILE PROVISIONS OF <br />rx ❑NO <br />ANY 01111111 STATE DIE LOCAL LAW ILL GULATIA!(i COM:T IIUCTION <br />STATE <br />TYPE OF CUNST OCCUPANCY GROUP N0.0P OWI LLIN^ <br />;. <br />UNITS <br />MAX.00C. LOAD <br />011 THE PERFORMANCE OF CO NSif1UCTION <br />I <br />Sl tQl /OQF I�B LDG. NO. OF STORIES <br />��/ <br />"'r'I,� <br />&GN CONTROFi AUT11. AGE NT OATE7/7/W <br />-I_ <br />1111k ZONE --- II/AGI MIaJI <br />11Hk !:1'Ii1NK LLlh <br />R-O� <br />t <br />i� �r(�'�j <br />RLOUIHED <br />els 2f4o <br />Plr:N aHLCK NUMIIER PLAN CtiLCK I EL <br />FtECE Orr No <br />SPLCIAL CONDITIONS: <br />. <br />I LE <br />111 (/V+A"LUAT_ DN <br />-.4I� <br />_ FEES FEE <br />i <br />BUILDING S <br />SEPA REVIEW COMPLETE DYES ❑ NO <br />PLIIMIIING <br />contact plannlnct dept. <br />M(CtIANICAI <br />0114ER 1 <br />iAAIICAl10N AUd M.... Y(AN9 L'NIMLU YY. <br />TArr+ovlo ON s Ar f-Ilr <br />PENALTY TSF0.00J IY1L_l' <br />