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► . - con�s�� uc�Eo►v � <br /> PER�VIIT APPl.!CATIt�N � <br /> COMEINATION • BUILDING • MECHANICAL • PLUME3ING <br /> OWNkN / MAILAUUNtSS� ZIP PMUNt <br /> 7c�ct.n�� e I a-h 3-3L� o�- .,� i} 2•:] 1 <br /> ARCMITECT UH DE51(:NkH MAIL ADDBL55 VMONE LICENSL NU. <br /> GEN�ERAL LONTNACTOR I MAIL AODNESS I . PMONE � LICENtiE NU. <br /> 1\ 3 �1 [ �' +er5�"l /�!/3 c.vz�n �, 7_ ,25`%-? 8Yj !-�C-TC- RG -C73c���2 ' <br /> MECNANICAL ONTRACTOq MAILAOOflE55 PHONE LICENStNO. ' <br /> /LUMtlING CONT,RACTOR MAIL ADORESS VHONE LICENSE NU. <br /> VERMIT - CLASSOi WOHK • �— <br /> ❑COMBINAT:ON . ' <br /> �BUILDING DPLUMBING �MECHl�NICAL � <br /> . ❑NEW ❑/1DOITtON QALTENnf1UN �NCI'nlii <br /> VALUATIONOF WORK --' "�'--' '-- - <br /> : 2 � �/� °�� <br /> ❑OEA10l15N ❑FENCE ❑SIGN ❑':\Y�MMINti POOL <br /> DESCP18EWORK `7 ') ' I.�:��i � �o� �2Ci'Jel" �� � '-I �.rS�.a�� 7�pS�C� �)o:7r.� n,l <br /> tiei �,� � — + r�•��k d1.� <br /> ' • �ii�,l�F '1 � i.�.� � ,co.�. Cde�: „. <br /> vaovoseo use OTHER PERMITS OR APP VAlS <br /> � REZONE � SPECIAL USE <br /> LEGAL Ut5CR1YTIUN OF VROPERTY ISMOW UEIOyY�R ATTACM <br /> `o�p 3P��'��� -7�7 ''"'� #VARIANCE � SHORLINE <br /> LOT BLOCKLLOF '+�3��- 7Y7-PO 3-COuS , � <br /> I a F_"�- d:v 'H" SEPA CHECK UST REflUIRED <br /> Lf YES <br /> Li NO ' <br /> JOB ADORE55 ,/ I �[� [ <br /> �'30 /'/Uryo�'1 L' v� o'�.T' �MECHANICAL <br /> PLUMBING ' TYVE OF ENEFGY � ' <br /> � ❑.n5 ❑ELFC. <br /> . NO. TVPE OF EOUIPMENT� FEE <br /> � AIRCOND.UNITS-N.P. EA. �5 I <br /> NO. � 7YPE OF FIXTURE OR ITEM FEE RLiRIGERATION VN�fS N.Y. En. j - -T <br /> NAIM TUIIS 5 ' - "' ___ "'_'__'___'_�__ 1� <br /> OO�IERi 11.F EA. j I <br /> CLOTNES YlASHF.H � • pOfICED AIR 5'/STEM H.T.U. MEA. T- <br /> DISIT YJASMEIlS � "-' -"' -_'"' � <br /> CIIINY.1Nu FOUNTAIN5 �. ' � <br /> - '-T <br /> FInOH OIIl�If�y � SPACE L WALI MEAiEHS P.T.U. � <br /> KITI:H6N tiINKti & DItiV. --�— UNIT IIEnTERS 9.T.V. I <br /> HAItSINKS � EVAPOHI�IWECOOLENS �- <br /> NOOFDRAINS HAINLEADEf75 ' � CLOTf1[5Ot1YLn5 1 <br /> . SHO�VEH flnTHS VENTILnTION FnN—�---r— <br /> 5[FiVICE SINY,S " -T <br /> SUMPS -� S[WA(iE PUMP RnNGE MOOU I <br /> URINAlS � " AIH.HANDUY.G VNIT_ . ._.._ C.f.M. . I <br /> WAIERCLnti[.75 � -' _ -. ..__.._ 1 <br /> WAlEkI 11f:ATElIti - ELfCi'RIC � � WATEN HFATER '.... _ . . . _ _... .T- <br /> _ ". ..'_ _ _ 1 <br /> WASt1 �ASINS - � fAC. UVIIT FIREPLACE h CHIMNEY 1 <br /> IAUN�RY TfiAYti 6A5 SYSTEM: NO OP OVTlF15 T <br /> . ._." '"". "" <br /> " " _' '_'_" ... .. . _ . . _ ." _' '...L� <br /> � ' �U(ITOML 5 I <br /> � __......__ pERMIT ._5..._.._"_T_ <br /> _ 1 '__-_____ _—"'_'_"' _l_ <br /> SUD TOTAL TOT4L FfE 5 1 <br /> � i1115 PF.I�M111T [IECOM1IES NUI l l�ND VqIU U lYUi1K ON f.045TRUC <br /> PEHhiIT $ � iION AUf1�0li12CD IS NOT f.Otd61lNC(D WRHIN t?0 UAv::, OR �F <br /> TOTAL FEE CUNSTNVCf10N OR WOpK Ri CiU51'I'ND[O O11 AtlANDONGD FpR .1 <br /> V�ATER S�F.RVICE SIZE BLOG.SUM.^!.V SIZE PFnion oF t�u onr5 n� nrvr I�M1� AFTER1VOf1� I1:CDNldFNClD. <br /> a�u[ rqMU � . A � UACA HlAHYAHDSET(1ACK� 1 HCRLOV CERTIFV TNA7 I 11AVL NEAU AND EXNdINlO T1115 Aa. <br /> - PUCATIbN l�NO KhOW THE $.\NE Tf)Iil TftUi: ANp COI1NfCT. AL� <br /> PqOV1:lONS OF LA\VS ANU QfiUINANCE$ GOVEiiNWG :NIS TYP: <br /> � OF WOHK \YILI BE COMPLIEL' WIIN Y;IItTNER :7V[CIFI![] HEHE�\ <br /> US[ ZONk LU7 AHLA VACANT SITk OR NOT, Tllk GRnN.-W:. OF A PEHAtIT OOCS NO� P��ESVh1E t0 <br /> , . GN[ A111110q�TY TO VIOLAfF ON CANph� illF �'�UVISiON$ OF <br /> ❑YES ❑NO ; qNV OTHC.R STATE OR LOCA� �A1Y IILLVLl�TINGCONtiTf1UCT10N <br /> TYVEOFWNST. OCCUP/1NCYGHUUY NOAfDWkLIING ��7H�PERFOHMnNCEOfCUNSfRUCiiON. <br /> UNITS ,-� � � <br /> � � <br /> }QE OF OLOG, NO.OF STONIES MAX.00G LOAO C�.� ' � <br /> . x � c_ �� j� ,�Ld-ti+!� i- �- 7�� <br /> �.._. <br /> IIi1t2OIVt jj/1I{L�MLtJT IINL!1PIIW/:11115 �SIGNATU�COPCONTRACTOIIOHAUTIII�GBNT nATC <br /> Ht.0U1HEU � ILANGNICI: NU6IULH 1'LANGI�LI'AFh! <br /> � ❑VCS ❑NO ILC . IICCEIPTNfI. <br /> i�FC1AL'CQNDITIONS: <br /> .. ..,.�....._�_.�.._ .. . . � . .. .... . .. . _.. .. _.. , � <br /> FCES VALUATION FFE <br /> _ _ �_ '_"_T_ <br /> __ `___ I <br /> � V . OUILDINC S � ' <br /> '. ___ I " '__ ' '....4�=�_�._.� _ .,;=..r'� <br /> SEPA REVI@W COMPLETE � ❑YES [] NO ' riuumNu � <br /> confoct q p . ._ .--.—••- � <br /> plonn�n de �. MLC/IANICAI t <br /> _ . _. �-_..... <br /> ' ornen ' � <br /> i <br /> tiuutwNRc�Vllu�v: ruwYtHluiu�v: u'�v�o O+aw�K1�r PENALTV SCC. �O]Id � <br /> � � <br /> _�__' _ _.._�...""' .._... _�_._._.. ._. <br /> � TOTAL � <br /> .�-•- ---'-----�-•--- ' �'- � { i <br /> � f <br />