Laserfiche WebLink
C' ISTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL PLUMBING <br />OWNER MAIL ADDHLSZi ZIP PHONE <br />�1L Wrrfu7i d� PAN ZA C� i�f//R�[/dirt <br />11RCMITE CT OR OESI GNE li Id 1 ADDRESS PHONE LICENSE NU <br />DENERAL CONTRACTOR MAILADDRESS PHONE LICENSE NO. <br />Ce <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT CLASS OF WORK <br />D CO MEIN ATIO N <br />110 BUILDING ❑PLUMBING []MECHANICAL ❑NEW ❑ADDITION ❑ALTERAf1ON �40'Alfl <br />VALUATIppgN Of WORK <br />Coo - <br />DES ❑DEMOLISH ❑FENCE ❑SIGN ❑'.:VIMMIN(i POOL.CRIBE W RK <br />Jof b <br />PROPOSED USE OTH -PERMITS OR APPR' Alb - <br />�IfN?>l LAG? •i1 REZONE � SPECIAL USE <br />LEC•AL OESCRIPTION OF P OPE RTY fSHOW BELOW OR ATTACH {- <br />FOUR <br />�I�,CO�-PI (E' <br />S) �, � VARIANCE 11 SHORLINE <br />LOT ��/L�BLOCK�OF�L' %z irkSEPA CHECK LIST REQUIRED <br />1t YES <br />]Zt NO <br />JOB ADDRESS <br />MECHANICAL <br />PLUMBING TYPE OF ENERGY ❑I:AS -- ❑ELEC. _ <br />NO. TYPE OF EQUIPMENT FEE <br />AIR CON O. UNITS-H.P. E_A. -- �S -v <br />- '- NO. <br />TYPE OF FIXTURE OR ITEM FEE V REF RILIERATION V_ -_ N.P. CA. _--�-_ i <br />IOUS S BOIL EnS H?. EA. CLOTHES WASHER 1 FORCED AIR SYSTEMS O.T.U.. MEA. --!- _-y�- <br />Y::.5HE135 I -_-- --.._. <br />KING FUUNTAINS I it <br />- -CE h WALL HEATERS - O.T.V. -- L_ <br />R DRAINS I IT TIE ATE RS H.T.V. �:11EN SINKS h DISP. APORATIVE COOLERS $INKS I-F DRAINS RAIN LEADER$ I OTHES DRYERSWER BATHS NTILATION FAN <br />VICE SINKS NGEHOODP$ -SEWAGE PUMP q IIANDLINf. UNIT C.f LML- __„-__,-y <br />NALS .__ 1 ER CLO.SF:T$ - - WATER I/EATEN _ _ En HHF.ATEIIS - ELECTRIC H BASINS FAC. BUILT FIREPLACE &CHIMNEYNDRY TIIAYS - GAS SYSTEM: -NO OP OUTLI.IS _ -�-- <br />I -- ----I;E RMIT -S •.- <br />I ----- TOTAL FEE _S <br />$UH TOTAL T1115 YF.nM1T OECOMES NUI L AND VOID II WORK ITN CONSTRUC <br />PERMIT_ S .T� TION AUT 101OZED IS NOT COMML LACED WIT 111N 120 DAYS. On IF <br />TOTAL FEE CONSTq VCTIDN OR WORK IS SUSPI: LADED Oil AnANDONED FOR A <br />WATER SERVICE SIZE ULDG. SUPPLY SIZE PEnloo OF 170 DAYS AT ANY TIME AFTER WOnK IS CO\11.IE LACED. <br />I IIEREIIV CERTIFY THAT 11IAVL 11LAO AND EXAMINLn THIS AP <br />K HEAR YAROSETBACK.. PLICATION AND KNOW TILL SAME TO Ilk TRUE AND CORIO CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES OOVEnNING T141S TYPE <br />_ OF WORK WILL HE COMPLIED WIT)/ WNETIIER::PECIFIED HEREI0 <br />UNoy PRESUME <br />31. ZONE LU7 A/LLA VACAf:i SfTL -^- GOn NOT. TOL OF A PERMITIVE AUTHOR TY T01NG V VIOLATE Oil CANC LESIIE PROVISIONS OFI <br />DYES ONO ANY OTHER STATE On LOCAL LAW OLGULATING CONSTRUCTION <br />TVPk OF CONST. OCCVPANCV OgOUP UNITS DWELLING <br />On 71.E PEnFO RMANCE OF CONSTRUCTION' <br />r y <br />512E OF BLDG. NO. OF STORIES MAX. OCC. LOAD x � T / <br />_ SIG REOFCONTRA TOAORAUTII. AGENT DATE <br />/ 11/! LC]Nt 11/1:ik M6NI REQUII'HINKI.LILS LAN CHECK NUMBER PLAN CHLCK I LL <br />REQUIRED <br />- DYES ❑NO - TLC RECEIPT NO. <br />SPECIAL CONDITIONS: <br />___.—.... ._ .. ....... FEE . <br />FEES VALUATION _ <br />_ 1 <br />BUILDING = I <br />_ I <br />- r PL IIMBINO <br />SEPA REVIEW COMPLETE OYES ❑ NO <br />Contact Plannlnq dept. MI.CRANICAL <br />1 <br />OTHER -� I <br />SEO 00]Id <br />M7lIGI1Orr PLl Vllu lr rLnNanl lR11111• Mleuvlu UMI 6A AKI YY PEN AL7Y <br />_.__.... _ _.-.-. . _... _-.- ...I <br />TOTAL L 1 <br />