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- CONSTRUCTION <br /> PER�vIIT APPLICATION 3��/�� <br /> y <br /> COMBINATION • BUILDING • MECHANICAL � PLUMBING <br /> OWNEH MAILADDNESS ZIP YMUNE <br /> /r/ i �- <br /> r�.St:{�J'.i^=<•`� /�%:[/.'(/.+i/(-'• ��/ 1�J �., I t' ' - <br /> 'AflCHITECT UH OE 14NEH (. ,• •�' �I J/ � l :� . _j; �,-�-; <br /> MAILAODftE55 PHONE LICENSENU <br /> GEA[RALCONTRACTOR MAILADORESS PMONE � LICEN$ENO. <br /> MECHANICAI CUNTqACTOfl MAIL AOORE55 PHONE LICENSE NO. <br /> PLUMtlING CONTRACTOR MAIL AODRE55 PHONE LiCENSE NO. <br /> PERMIT CLASSOF WORK --' ' <br /> ❑COMBINATION <br /> ❑OUILDING �PWMBING �MECHANICAL <br /> ❑NEW ❑ADOITIUN ❑nLTEfinflON ❑11({'n111 <br /> VALUATIONOFWORK -- ---�-- ��---.- <br /> �� �� ❑DEMOUSN ❑FENCE ❑SIGN ❑':�VIMMw<: f`UOL <br /> S ,.\' L .� <br /> OESCHIOE WOAK � <br /> / ''�� <' .C' N` � <br /> YROPOSED VSE ' <br /> , OTHER PERMITS OR APPROVAlS <br /> LlGAL UlSCRIPTION OF PHOPERTY I$HOW BELOW OR ATTACH '� RE ZONE � SPECIAL USE <br /> FOUH COPIE51 . ' <br /> �or!'� .� BIOCK-��'��OF ��� � ' %%� -�� /��.� �VARIANCE � SHORLINE <br /> SE PA CHECK LIST REQUIRED <br /> L7' Y ES " <br /> � / � I� N O ' <br /> �0 i ( ,� , � �„i �'�/'�' >F <br /> J08 ADORE55 <br /> �MECHANICAL <br /> PLUMBING TYVE OF ENEHGY � 'n, �ELEC. <br /> . NO. TYPE OF EOUIPMENT —� FEE <br /> . _'_ '__' . . ....__"_ _ <br /> AIR CONO.UNITS-/I.V. EA. 5 �� � � <br /> NO. TVPE OF FI%TURE OR ITEM FEE RkFR�GERATION VN�(5 II.V. [A. _— _—T— <br /> NAIHTUII$ S --' OOIlERS IIP. [A. ' ... ..—.�.--.��-- I <br /> CIOTr�ES WnSHEH � ' FORCED AIf1 S�STEMS R.T.U. MEA. -�— <br /> UISH WASHEliS � _ _..._. ___. _. ... y� � � <br /> URINKING F(]UNTAINS � '--1 1 � <br /> FLOOH DHAIN$ � SPACE b WALL MEATEFS fl.T.U. � <br /> KITI'HtN tiINKS 8i p151'. � VN�T 11EnTERS tl.T.U. � <br /> IiAfiSINNS � EVnPOHnTIVECOOLEHS �— <br /> NOOF DRAINS RAIN L@A(iEHS i CLOTHES ORVE�S ` � <br /> SH(71VtH AAT/15 VENTILATION FAN T� <br /> SEHVICE SINKS --- t <br /> SUMVS - SEWACE PUMP A�1NGE NO00 _ —�—� � <br /> AIH �Il�ND�INC UNIT C.f.M. --�— <br /> URWALS � '_"—".'.___'_.... <br /> . ..._. ..._..._.._ !'_"__' � <br /> WnTER CLOSE.TS � . _ . _....__'. _._.._ ..__ . . . _ ._..._.. ._ T <br /> "-"—' -' -' WnTER HEATER � ' <br /> WATER HFAiEHS �� ELECTRIC i ..._ _. __. __'_.'."_ _ _ ' . ._. .. .^ , <br /> WASH BASINS - � FAC. BVIIT fIREPLAC[ & CH�h1NEY C � <br /> LAUNDflY TftAYS . . _" _. .. ... .'—" —".._.. ...._.."'__...." "" _"'T__ <br /> f.AS. $VSTEM: NO OP OVTlf.IS � �_ <br /> � • _ -- '-"'- � � ��UO TUML 5 � <br /> � —"___ _'—...___.�ERMIT _"_S .._.�.�_�_ <br /> SUB TOTAL Toint. FfE 5 1 <br /> � 71115 PF.fIM1T OECOMES NUI l l�NO VOIp 11 \YUnK 11H QUMSTRUC <br /> PERM17 S TION AUf110li12ED IS NOi CO`dMCNC[O �VIIIUN 1?0 C.1Y5, OR tF <br /> T07AL FEE [pry$TRUClION O!1 \401IK I:i SU::1`I:NpED Oli AOAND09[O FpH A <br /> WATER SERVICE SIZE OLDG. SUPPLY SIZE NklIIOD OF 1Y0 OAYS AT ANv IIMI�. Ai �CH\VOfIK I:;[P411.1ENCEU. <br /> � A 'K HLANYAqOSETUA�K, � ���Rt��� CERTIFY T114� 1 II/1V[ IIGAU ANn C�fAMIN(O �1115 AP <br /> PIICATIpN ANO KNOW THE SA�tE TO IIF TfiUL' ANb C[`RNECf. ALL <br /> ' Pqf1VISION: OF LAIYS ANU GHOINANCES GOVERMNG THIS T\'PE; <br /> USE ZUNk � �U7 AHlA - - ---- OF WOHK WILL 6E COh1PLIE0 WII11 W1itTHER ::PF.C�F1[b HEHEINI <br /> VACANTSITh OR NOT, THE ORANPWG (1P A PERMIi ppCS NpT VRESUME TO! <br /> ' ❑YES ❑NO �'�VE AVTIIOt�ITV TO VIO�A�6 OH CANCEL i11E �'RUvI$iONS OF <br /> '. ANV OTHER STATE ON LOCAL I.AW HL(iV1.AiING CONtiT11VCTION <br /> TYPE OF CDNST. OCCUPANLY GHOUP NO.OF DWELLIN(: OR 7NE P[RFORMANCE Of CONSTRVCTION <br /> UNITS i <br /> SIZE OF OLOG. NO.OF STOFIES MA%.OCC. LOAD <br /> X <br /> IIHlZONt IM?;kMlfVT iTL.•:I'NINKI.l,l1.S SIGNATUHEOFCUNTRACTOf10Hl�UTIIAGENT pATE <br /> REOUIHEU ��qryCHLGKNUMUEH YLANCHlCKF6t <br /> ❑VES ❑NO {4L' f1ECE1Pi Nf� <br /> SPECIAI CONDtTIONS: <br /> FEES VALUATION FEE <br /> _____�_ _ _'___.,_� ._'_'_r—_ <br /> I <br /> I �J �� OUILDING S � <br /> � . —_ ._ _� � _.._""_"_ _ '_""'r'�. <br /> ! SEPA REVIEW COMPIETE � ❑YES ❑ NO ' "�"'"n'"" � <br /> ..._ . ._�._.. i <br /> . conlacl p�a��inq CICPL MECIIANICAL • j <br /> . . �.—. _. <br /> OTHER � <br /> I <br /> AN���ALOMII[L111�pYY'. YUNSCMIGS\UYV: AMIpV10 ONIS,U�KIYY PENALTY SEC. JOJI�I � <br /> I � ���_ � �. ._�.._���.. ��' �.���._..���. <br /> � � <br /> rorn� � <br /> --- - ----- ---- --- - - � <br />