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- CONSTRUCTION <br />PERMlT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />� 'I' _. ,'. . � <br />�COMDINATION <br />❑OVIIDING []P�UMAING �MhC1iANICIII <br />JAIVATIONOFWORK - <br />IVNOF <br />LOT.�-�'L Bl0[K_ <br />�� •� � <br />�� �v . <br />nOD <br />.o/�'. ; ,. <br />,�y�z <br />� �•MUNE <br />( . ` " � J <br />�-��� . . _ <br />L �_ <br />N U. <br />ONCW ❑ADDITION ❑nLTEflnfulN ❑I�U'n�ll <br />❑OE610USH ❑FENCE ❑$IGN ❑':�VIA1MiNf: PUp�. <br />� OTHER pERMITS OR APPROVAIS <br />oA`nrTncN � RE ZONE � SPECIAL USE <br />�� �Z �VARIANCE L� SF'ORLINE <br />SEPA CHECK LIST REQUIRED <br />.L� YES <br />y� N O <br />JUB ADOHE55 <br />a �� ' ' � �� � � ;: . � � '" � - - � MECHANICAL <br />PLUMBIMG rvvE oF BNEHGY <br />� ' ❑r,n8 ❑e�Ec. <br />_ "'____ _ .__ . .'"_' ___ <br />. NO. TVPEOFEOUIPMENT FEE <br />_-'___ . _ .. ....__..._ ..._ <br />AIRCOND.UNITS-II.P.EA. S I-_- <br />NO. TYPE OF FIKTURE OR ITEM FEE �-� - ' '� �----' �"'-' ` �"'-"' -"'---T'- �----T—'- <br />- __ Rtl'RICiEf:ATH1NUNifS IIY f,A. ..__�____1__. <br />Iir,��,lUtlti S ..__ .__._ .______._'___._'___.. <br />f101thRS I/P.EA. <br />CLilfN55'NASMEN i - ' - '-- ' ..-' __.1__T__ <br />OISl1':o�tiNFii$ � _ f0110ED AIH 5_STFM,^. 0.7.U: M[A. ____L__ <br />UIIINY.ING FUUNTAINS � _ _�_ <br />F10�1N DHAI��S � SPACE !4 Wt1l.L MEA1[PS ^H.I.U. � <br />KI7l7HhN ti1NY.y R UISY. � VNIT HEATERS N.T.V. � <br />UnN SINKS ------- -- -----� --�-- <br />FVAPORATIVE COOL[HS <br />iIUUF DHAINS RAIN L@AU[{IS �T— _1 CLOTHLS DRVEfiS ""--"'-'"' —'�- " J. � <br />SHOI\'6R flATH$ V[NTILATION FAN T�� <br />`i[N\'ICE SINK$ � -� '---' I- f � j� <br />5VA1V5 -� SE\VA(iE "'JMP _ �nNGE 1100D /!r• I-' <br />UIIINAL$ � AIN IIANOLING VNIT C.f.M. � <br />_'. _ __�. .... ._. ...._ <br />�_�. � <br />�_"� <br />WNFN Cl0}I rS � . . ..._. . ._ ... . _. ._�_ <br />F KATER Hf._AlEll: h�EC1�RIC i WnTEH NEATE�i .. . . "'�__ <br />WA'H OAS!NS - � FAC ❑UILT FIRE'lIACE !4 CHIMNEY � <br />LAUNUftV TqAVS , _ —1 _ C4S S�STE67. NO OF OVTLI 1S i � �__ <br />_ 1 - -- � " Vf1tOML 5 Q:%I <br />— -- � �.. . PERMIi S � �r--- <br />— -- SUOTOTAL � _ �-- -- � ttnnLFkk 5 � ��~ <br />i/�•�..� 11115 PF.IIhllT UECOMES NVI1 /�Nf� VOIU 11 WU1�Y. �1M (:UNSTItUi, <br />PERMIT 5 ���.� TipN AVillplilLED IS NOf ffVdMINC[D\VITIUN I?OUAY::, p(t iF <br />1_OTAL FEE S ('.� - CUNtiTRUCtION On WOIIK C: SU::PfNUEO tlll /�D�tJpOYEO 1'pll A <br />IATf.R srnvice iIZ[ �� (3LD�(i SUPPI.V $IT.F. �'���IOD OP 1]0 DAYS AT ANV tlMi�. AV �E11 W0(1� I:C�`N1.tENCEU. <br />� t al .1 n i�ci;,pipq�K HLANYn1105LT13ACK I 11CRlIiv CLf1TIFv TIIA7I IbIV[ lilnfl �1N0!`(n0.�rt:in tU15 nP <br />�-- FLI�4TION l�ND /:NOW TH[ .^..\�1L 10I11 TfiVC ANUCO1:11t CL AILI <br />��%�T �G � /�rJ�-- 7 PROVI!:IDNS OF I.AWS ANL` 01101NANCES f.UVEI�!:ihG it�i5 TVPt'i <br />..__. ..... _..._.,. .. ._._�/ c:__. 1�_ Of WOIIK \YILL BE COM1IPLIFU WITH Wn!(THF.R:�VECIF1lU �+CliElhl <br />/9l ZUNL LO7 AIILA N VpCANi fil:b pR NOT. TIIF 4R4N:ING fll' A Prqr�uT ppGS NOT PRF.SJ1'E TO� <br />�J I. ` '. "`, I GIVF I�VTIIOqITY ip VIOLAfE OH CANCkL fHE �'HUVISION: D(-I <br />,✓ U 1..,.� OYES ❑NO ./�NV OTb1iR $TATE O11 LOC/�L LAW HLGV1.l1TtNtiCOM:TfIVCTION <br />'VPE OI�CONSL OCCUNI�NCY (:FOVP NN;O�1' OWGI L4VG ��� T��k PCRFOFMANCE Of [ONSTIIVCIIpN' , I <br />'� � f-/J <br />SFlCIAL CONOITIONS: <br />SEPA REVIEW COMPLETE � <br />contact planninq dapl. <br />❑v[�.^. �No <br />❑YES ❑ NO <br />u <br />x <br />SIGNATUHEOfCONTRACTOf10qAUTH.AGF.NT f].VC � <br />� LAN CH[CK NUA11it11 YLAN GILCA I LL <br />� ILC ��ECEIPI Nt� <br />.. �. _7/! , ._'._� <br />FEES � VALUATION FEE <br />_ __ _' __ r'—r._ __... _ r- <br />OUILDING <br />Pl VMIIINfi <br />MlC11ANICAI <br />OTIIER <br />PENALTY <br />TOTAI <br />5 ' � � (�- Ci'��i 1-,, <br />0 � +� ' L• <br />...__.._—�-- — --..._-r-- <br />i <br />�°��- <br />I <br />. ; i <br />= �._ . <br />I <br />SEC.9071d 1 <br />_._......"'_'.. __.... _._._._._..l_�_. <br />