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- COI�ISTRUCTION 3c g2��� <br /> PERMIT APPLICATION ��z <br /> COMBINATION • BUILDING • MECHANICAL • PLUMBING <br /> OWN6H MAILAO�11k55 ZIY VHUNE <br /> CZ�C�\"_"'l r� � bt_rti 3 `-� / Lr No.,.}c:, �[�'f' FvCr�'`l. �6 0 ' � � <br /> AFCHITECTORDESIGNlN MAILAO�RESS PHONE LICENSENU <br /> GENCRALCONTHACTOH MAILAOORESS PMONE LICENSENU. � <br /> � 2. \�c.r,r�>��.... �a �r!.� ��i72`tc LX-3 "`�� S/=. f_1��.c`?;�dd' - ��.3 -C� � R•NP-NR-'.l� Go, <br /> MECHANICAICONTRACTOR MAIIAO�RE55 PMONE LICENSENO. <br /> PLVM8ING CONTRACTOH MAIL ADDRE55 PHONE L�CENSE N0. ' <br /> YGRMIT CLASSOF WORK • � <br /> �COMBINATION <br /> �OUILDING � PLUM�ING �MLCl/ANICAL <br /> ❑NEW ❑AOOITIUN ❑ALTE1t/�fIUN �nU'n1N <br /> VALUATION OF WORK � <br /> � U ❑�EAtOL15H ❑tENCE ❑SIGN ❑;\ViAtMIN<iYn01. <br /> 5 ' <br /> DESCHIOE O K � � • <br /> �Cc.f U �C' \C Ga i'I� ` ' ('u �^'�. . <br /> PROPOSLOUSE OTHERPERMITS ORAPPkOVAlS , <br /> � ,� RE ZONE � SPECIAL USE <br /> LlGAL Uh5Cf11PTIUN OF YPOPERTY ISHOW BELOW UR ATTACH <br /> FOU COPI " y <br /> �roT�'�_�eIOCKF270F�L F- (= v�rc-t{ VARIANCE SF.'ORLINE <br /> �� ,� SEPA CHECK LIST REQUIRED <br /> �J`.Ji J-+ c.c �.c,-.1: ..- �to -/'lr lsf ,I�' YES <br /> ,:� I...-1-r =j NO � <br /> 1y�.rcaF r�o. •�{�c:� i � V� I,._e `-/ �,� <br /> JOO ADDNESS <br /> , r_� J . .j��, r�� ��'� �MECHANICAL <br /> PLUMBING TYVE UF CNEfIGV <br /> U(:A$ ❑FIF.C. <br /> . NO. TYPE OF E�UIPMENT FEE <br /> __ -'- <br /> -'_ "_._ . . . . ._._'_'_ _'_"_"___ <br /> AIHCOND.UNITS-41.V. EA. 5 � <br /> NO. TVPEOFFItTUHEORITEM FEE RkffvlcEAnT1oNUNifS ��NEn� --� <br /> _-_..__ .�__ '__'.. . .'____-._ _.. . _""_"__."'^_'-___1__ <br /> HAIH TUUti S ' . _ p011tR. N.P. fn. _ _ __"�'T <br /> ClOT11E$ YlASHEH FORCED Alfl SVSTC�d� O.T.V. MLA. ' <br /> OItiH YJASNENS � .—. -..."'— '-- .. ...--'_-___ ' ___L'— , <br /> 1 <br /> OHINKWCi FOUNI'AINS i ' -' ' "—" '-" "-- -' -'-- <br /> PI.00H DIINNS 1 SPACE h WAIL ME4T[NS �� N.T.U, _ _ � <br /> KIT�7HhN tiI1JK$14 DISP. � UNil 4EATBRS B.T.V. _ � <br /> IIAVISINKS � EVl�f'ONATIVECUOLEN$ J _ T— <br /> NOOP OHAINti HAIN LCAI)EIIS T— CLUTIIES URvlRS � � <br /> SHO�VEH f1ATH$ VENTILnTION FAN I T— <br /> SBHVICL SINY,S � <br /> } _ RANGE I/OOD __ "_"_ --i I <br /> SUMPS_SB�VAGB PU41P —T <br /> UNINALS � Mft 11pNOLING VNIT C.�.M. � 1_ <br /> � '"' '_""' _'_"_"___ _. ...._ _..._.. r--.-..__' I <br /> WMEII CIOtifTS I . . ._ . ..___._. ..... _ . . . ... . ... ... _. <br /> ' ""-" "' -' -"' � WATEH IIF.ATGR T-_ <br /> WnT6N HEI11GIiti � ELECTfiIC � . ' ' __' ' .._ . __�. . ._. _..�_.__ <br /> _'_' ""_- . . . _. . . . <br /> WA:iH Ul�llNti � � FAC. OVIIT FIR[PLAGE 14 CHIbWEY 1 �i <br /> Lf�UNURY 711AVti CAS. SVSTEM: NO OP OUTLI 15.._.�_.. .."� " -""'T-- <br /> " __—"'_" . . .1-_ <br /> . .s�a��iurni 5 i <br /> � - '.-_. ."_PEIih11f .-5 '-'_.._=.,__ <br /> � -- '—"'_—"" -' TOTAL f k E _5� I <br /> SUO 70TAL � - . . _. __. _ .. . _ . _.._.. ' ' . '""__"' ' <br /> PERMIT 5 11115 PEfIh11T UECOMES NUI l �Nf) VOIU 11 \YUltl: VH f.UN$T�UC <br /> T�1TAL FEE �� TION AVf110RIZEU IS NOT CO`.�41LNC[[l WITIIIN 1?0 D1V!i, Ofi iK <br /> CUNSTRUCIION pfl �VOIIK I:i iU::l`i ND[D O11 Apl1NU0^1[O FOii 4 <br /> cWvA¢�TER SERVICE SIZF. OIDG. SUPPLV 5121d N�niOo o�° t20 DnvS nT nNv �i�,tt AF tE1tNO��K 1::Ct�'.11dFNCFU. <br /> Siuc v�lnUaC n . � UAI,K HtANYl�HUSEf0ACR1 � ���HLUV CEf7TIfY fHAT I IIAVI NLAU ANO C`(l��"iNfO f1115 AP� <br /> . PI�CAiION AND I:NOW TIIF .^.ntilE TOltk TIiUEl�NOCONqFCT. 11.L <br /> Pf10V1510N$ OF l4\V: 4NU GHOINANCES GOVER4iNG TIIiS TYP@ <br /> Of WO�IK WIIL OE CO!•1Pl-�FO �YILN YnfE7HEft ::Vf.GFIfU 11EfiCIN <br /> USl 20Nb LO7 ANLA VACANf ti1TL Ofi NOT, 1'HL 6fiAN41NG OP l� vER\11T pp[ti Npl �'RCSV�.1[ Tp <br /> -_ GIVE AUTIIOPITY TO VIOIAfk OH OnNCbL THE "��OVIS�ON$ pF <br /> � ❑YE5 ❑NO ANV 0711GR STATE OR LOCnL LA1Y -�1f r�U1.AiW(i CONl:T11VCTION <br /> TVVEUICONST. UCCVVANCVGRUUP IVO.OFUWkLUNG ORiMCPEIiFORR7ANCE0iCONSTnV��iON <br /> UNITS � <br /> SIZE Of OLOG. NO.OF STOHIFS MAX.00C. LOAD ^ � <br /> x , . . � � <br /> -�'""_�'`.1 �i, �,�--� -s..._— <br /> SIGNATUHEOPCONIRACTOlIDRAUTII.AGENT pAT� <br /> f IIIL 2ONL IIAGLM'LNI I IIIL!'.1'111NKI.LIIS <br /> ' HIOUINEU ,L:�NCNLCKNVM1IULH VlANG11LCAf�ht <br /> -- _ ❑Y[i ❑NO _ __ ��.� IIIECE��T Nn <br /> SPI:CIAL CONDITtONS: <br /> FEES v VALUAT�ON � FEE <br /> _ _ ____._' ._..._...T.___' <br /> I <br /> __'___._�_�_.�_. _.."'_ __ _ ____L� <br /> I <br /> —"�"-�—'- BUIIDING S � <br /> I � " ' _' —' . .. .'_"....._.._� _ '__"""'i'."' <br /> f "_'�'-'-- � Pll1MI11N1: <br /> : SEPA REVIEW COMPLETE � ❑YES ❑ NO ..._ .. �.__.._ � <br /> conlact planninq depf. nac�inNicn� • � <br /> . . �__ . <br /> on+[n � <br /> i <br /> -----r-- <br /> ArolIC�110H�LllI1l0YY' YUMYCIIIClIUYY: AMOOVIO UNIy1U�N[IYY PENALTV iEC. �O�I�I � <br /> _..L..��. <br /> � � � TOTAL _ '.__'."__ ' _' ' __'. I <br /> ._____ .. _.'."_ .._.' ___'__ _._'.__'_ "__._'.. . +�+..c 1. <br />