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14,0 k��` - CC 'STRUCTION /14- 1- MOO` Y7 .0- <br />PERMIT APPLICATION �' y.'T <br />COMBINATION III BUILDING • MECHANICAL • PLUMBING <br />OWNS MAIL AUUHLSS ZIP PHONE <br />�C11/t�+>v0 2 4 �( C .2S — <br />ARCN ECT OR DESIGNER MAILADDRESS PHONE LICENSE O <br />Z.�C'. C �f6�4 ♦ L: �S�Nit'"L(/I.wa ;Z,�r- �y�y <br />(TCNL ok CON RACT OR/� MAIL A ADDRESS PHONE LICENSE NO. <br />)VFWD Fr)i G 14 yrTd/>/ <br />ME HANICAL CON T RAGTOR MAIL A50RESS PHONE LICENSE NO. <br />/CLIMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT CLASS <br />Of WORK ' <br />❑COMBINATION <br />BUILDING ❑PLUMBING ❑MECHANICAL <br />❑NEW__ADOI TIUN ❑ALTkT1A THIN ❑H[I'AIII <br />VALUATION F WORK <br />S �yoo % <br />-- -- --_ _ _ <br />❑DEMOLISH ❑FENCE ❑SIGN ❑'IWIMMIN({ POOL <br />DESCRIBE ORK <br />-ralo It <br />PROPOS D USE pw vIrTS <br />OTHER PERMITS OR APPROVALS <br />ft <br />£c%ie J �jaA�E f RAF' <br />Jx REZONE tq SPECIAL USE <br />VARIANCE 11 SHORLINE <br />LEGAL CDESCRIPTION OF PROPERTY ISH W BELOW UR ATTACH <br />FOUR <br />LOT BLOCK_OF-- <br />SEPA CHECK LIST REQUIRED <br />��(ftO ui <br />= YES <br />' <br />y1 NO <br />7011 A6D`RLS <br />MECHANICAL <br />PLUMBING <br />TV PE <br />OF ENERGY 0GAS ❑E LEC. <br />_ TYPE OF EQUIPMENT FEE_ <br />--__�S <br />�—•_ <br />' <br />NO. <br />AICORD. UNITS-H.P. EA.I_ <br />R _ <br />REFRIGERATIONUNITS 14P LA. -1 <br />- <br />II P, EA. 1 _ <br />FORCED AIR SY STEM'3 I1.T. U. MCA. -- L- <br />-- <br />— '_--- - ---- — <br />SPACE A WALL HEATERS fl.T.U. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />ItA1N 111tlS <br />�Sl <br />CLOTHES WASHER <br />1 <br />— <br />DISH <br />Ur11NKING FOUNTAINS <br />1 <br />F 1.00R [TRAINS <br />1 <br />------ <br />UNIT HIE ATE HS N.T.U. <br />- — ---- <br />I <br />T <br />SINKS & DISP. <br />1 <br />LIAR SINKS <br />LIAR SIN <br />1 <br />EYAPD NATIVE CUOLE HS—_--_L— <br />I <br />HOOF DRgINS RAIN LC AI7EBS <br />I <br />CLOTHES DRYERS __ <br />-T— <br />$//Ol\'ER MATHS <br />VENTILATION FAN <br />SERVICE SINKS <br />RANG, HO0O <br />5UMY5 - SEWAGE PUMP <br />-- <br />_.. <br />.AI H.IIA NDLING_UNIT. .•. .•... C_T _M_. <br />... ....___. ._..... --. . _ ._".._.. <br />WATER HEATER <br />.._ .—_—_�— <br />_. <br />URINALS <br />1 <br />WM101 CLOSETS <br />_.__..... ._ _. <br />1 <br />.•. <br />I <br />WATEI711EATEH$ ELECT HIC <br />.__. <br />_ <br />_. _... ..—_....... . ... . .. ._ <br />FAC. BUILT FIREPLACE III CHIMNEY_-T-- <br />GAS. SYSTEM: -NO -OP OUTLl. 15 .__ <br />_ 'SUR TOTAL 5__.._ <br />.. <br />1 <br />..—_—•.__.T._- <br />WASH BASINS <br />1 <br />LAUNDRY THAYS <br />—"------�-"-- - TOTAL FEE S 1 <br />- <br />I <br />SUB TO T_AL� <br />_ _ .. —. _._ ._... 6.N — <br />11115 1'F.nN'IT IIECOMES NUI L AND V(lIU 11 WUIIY. OH C.II NSir1UC <br />TION AUTIIOn12CD 15 NOT C(IMMLNCI0 WITHIN 1?0 DAY$. On IF <br />CONSTRUCTION On WORK INSUSPENDED On An ANDONEU FOR A <br />PEnIOD OI 120 DAYS AT ANY tIMF. AFTEG WORK IS COKIMENCEO <br />PEH MIT_ _ <br />S� <br />TOTAL FEE <br />WATER SERVICE SIZE. BLDG SUPPLY SII.0 <br />-- <br />I IIERLIIY CERTIFY THAT 1 HAVE HEAD AND E`tAMINtn THIS AP <br />PLtCATION AND KNOW TIIL SAME TO HIE TRUE ANO COHHLCT. ALL <br />r , .• - 11A'K <br />HEAR YAHDSLt9ACK <br />PROVISION, OF LAWS AND ORDINANCES GOVERNING L)IS TYPE, <br />OF WORK WILL BE COKIPL IEO WITH WHETHER SPECIFIER HEREIN[ <br />UGL-ZONL � <br />LOl ARLA <br />VACANT SITE --- <br />OR NOT. TIIE GnAN.ING OF A PERMIT ODES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL T14E PROVISIONS OF <br />OYES ONO <br />ANY OTHER STATE On LOCAL 1 4 'UL AT INO CONSTRUCTION <br />OR THE PERFORMANCE OF THU CTII N. <br />TYPE OF CONST. <br />OCCUYANCV GROUP <br />D W LLLI N(i <br />UNITS <br />NITS <br />512E OF OLDG. <br />NO. OF STORIES <br />MA%. OCC. LOAD <br />15 HAUT11.AUEN 1y/ <br />OF CX T OL <br />IIAaMLN1 <br />: <br />FIHltitiONTRA <br />1; RtC H1NK1Lli <br />D. <br />LAN L'lIt CK NUTd0[R <br />PLAN CIlLjK 1 I <br />❑YES ❑NO <br />-79 <br />1I1,/• I:•`_RECEIPT NO <br />SPECIAL CONDITIONS: <br />FEES <br />VALUATION FEE <br />_ <br />I <br />BUILDING <br />i <br />2 (1d <br />.� <br />1 <br />PLUMBINO <br />— -•••- <br />SEPA REVIEW COMPLETE: OYES rI NO <br />contact Plannlnq dept. <br />MECHANICAL <br />... 1.. _.. .. <br />onlEn <br />I <br />1 <br />PENALTY <br />SEC, 3071F1 <br />KHIIGw Hue wLUrllu �Y <br />rieKsc•IIu(�IIr <br />w ROY1D OMI AyIvl <br />.. <br />H, V,, <br />TOTAL <br />1 <br />--_4 <br />.I <br />