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• CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING a MECHANICAL • PLUMBING <br />w <br />J11 <br />a <br />23-n/-S <br />TECHANICAL CONTRACTOR <br />'LUMBING CONTRACTOR <br />MAIL ADDRESS PHONE LICENSE NO <br />°ERMIT CLASS OF WORK <br />❑COMBINATION <br />[]BUILDING ❑PLUMBING ❑MECIIANICAL ❑NEW ❑ADDITION ❑ALTEF%A(ION IILI'Aln <br />VALUATION OF WURK <br />CI, ❑DEMOLISH ❑FENCE ❑SIGN ❑'iW IMMIN (: POOL, <br />S AI,jn0 <br />PRUPOSEU USE OTH ER PERMITS OR APP ROVAlS <br />r-1 RE ZONE SPECIAL USE <br />FOUR CIOPIESIIPTION OF PROPERTY (SHOW BELOW UR ATTACK {--* VARIANCE SY.ORLINE <br />LOT BLOCKL.o=OFEEK-tom F v - SEEPA CHECK LIST REQUIRED <br />]� YES <br />=j NO <br />cJ /y Q a Ces <br />JOB AD1DRESS <br />1 M'.•CHANICAL <br />c <br />CY4,4 <br />TYPE OF ENERGY ❑[: AS UELEC. <br />-UMBING <br />---......---..._.--f - FEES <br />TYPE OF EQUIPMENT _ __-s_..—._— <br />• NO. _ _ _ <br />AIII COND. UNITS_- H.P. EA. _ <br />FEE RLf RI(iERATION UNITS-1111 EA. <br />10. TYPE OF FIXTURE OR ITEM <br />S — BOILERS HP. EA. _ __-j__�-- <br />11A1H 7IIRS <br />.—__L--- <br />FORCED AIR SF SSTEMS lI. T.V. MEA. <br />CLOTHES WASHER <br />-_.-__ -- - ---- I <br />UISH WASHERS <br />OBINKING FOUNTAINS <br />I .�_ <br />_ -____. ___-- -- `r-- <br />I --'-� SPACE b WALL HEAVERS H.T.U. I <br />FI OOH DIAAINS <br />_- --�•-�- <br />UNIT TIE ATERS O.T.V. �-- <br />I _ <br />KITCM-N SINKS b UISP' <br />I _ <br />EVAPORATIVE COOLERS _ _-- ' <br />I ------ ---- - I <br />IIA1I SINKS <br />CLOTHES DRYS RS---r-�— <br />_ <br />1100F DRAINS RAIN LEADL RS <br />I �- VENTILATION FAN I <br />SHOWER RATHS <br />_ - I <br />RANGE HOOD <br />.`>f�liVl(:E SINKS <br />SUMPS SEIVACiE PUMP <br />---__. <br />C.F.M. 1 <br />AIR IIANDLIN6 UNIT ._•_.-„•_... ._.•-_-• I <br />WRIER CLOSET$ <br />HEATER - . -- - - -• t---"^ <br />__.. •I <br />_. <br />WA1 :11 IWATEIIS - ELECTRIC <br />_WATER <br />_ -- FAC. BUILT FIREPLACE b CHIMNEY <br />_--OAS. <br />WA!iH BASINS - <br />I __ <br />SYSTEM: NOOP OV TU.ISLAUNDITV <br />TFIAYS--'1UR <br />TD toPERMIT <br />I <br />TOTAL FEE <br />__RS PF. IIMIT BECOMES NULL AND VOID 11 WOII/'.OH CONSTRUC <br />WITHIN 1?0 OAV5, OR IF <br />PERMIT <br />S )ION AUTHORIZED IS NOT CONIMLNC(D <br />CONSTRUCTION On WORK Oi SU::PF NOED On ABANOONEO FOR A <br />AFTLF%WOnK L':Co%IP.IENCEO, <br />_ TOTAL FEE <br />VAILR SERVICE S17F._ _BLnG. <br />PLRIOU OF 120 DAYS AT ANY TIME <br />SUPPLY SI7-E <br />111[REIIV CE RIIFY TIIAI I HAVE IILAD AND C.CAL^INlO f1115 A <br />TO IIL TRUE AND COIiRFCT. ALL <br />I.1C <br />„ 1 A K <br />lit AM YARD SL TBACK. PLICATION AND KNOW TIIL SAMER <br />OF LAWS AND OHGINANCES GOVERNING 11115 TYPE <br />PROVI•;IONS <br />OF WOIIK WILL BE CON1P(.IED WITH N'11ETHE(1 SPECIFIED HEREIN <br />PERMIT DOE!; NOT PRESUME TO <br />Un ZDNL - <br />LUl AHLA <br />_ <br />VACANT !)ITL <br />OR NOT. TIIE GnANTING Of- A <br />GIVE AUTIIUn17Y TO VIOLAFE OH CANCEL TIIE PFIUVISIONS OF <br />IILGULATING CONSTIIUCTION <br />❑YES NO <br />ANY OT11En STATE On LOCAL LAW <br />OF CONSTIIUCI IONI <br />OR TIIE PLRFORMANCE <br />fYYE OF CONST. UL•CUPANf.Y L:ROUP <br />UNITS DWELLING <br />NO. OF STORIES <br />MA%. OCC. LOAD <br />qLJ <br />512E OF BLDG. <br />SI Nl/AT UR ET f CONTIIVRIIAC'T011--OR AUT!1. AGENT <br />II/L ZONF MAGI. ML NI <br />I INL !iYNINKI L115 ' <br />RI OUIRLU <br />PLAN CIILCK <br />Lr\N CHECK NUMBER <br />F LL <br />NO <br />❑YF5 ❑NO <br />iLL' <br />11 ECEIPT <br />SPECIAL CONDITIONS'. <br />I <br />. - - <br />VALUATION <br />-- <br />._FEY <br />SEPA REVIEW COMPLETE El YES ❑ NO <br />contact planninq dept. <br />UbI L111 LA1 U-1 <br />BUILDING <br />Pt uMnINR <br />MLCIIANICAL <br />OTHER <br />�♦ PENALTY <br />TOTAL <br />$ <br />1 <br />I <br />1 <br />1 <br />SEC. S071N <br />