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COP''TRUCTION <br />PERMIT APPLICATION <br />COMBINATION III BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL ADUHESS <br />ZIP PHONE <br />/ <br />��'� <br />Aa <br />/ /. _ <br />NV <br />HITECT 09DESIGNIL MAILADDHESS <br />PHONE LICENSE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />cAex1126f_M <br />¢�C � /y c� 0 f,' c� <br />MECHANICAL CONTRACTOR AIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR .� MAIL ADDRESS <br />PHONE LICENSE NO. <br />PERMIT <br />ICLASS OF WORK <br />' <br />[]COMBINATION <br />M4UILDING ❑PLUMBING ❑MECHANICAL <br />❑N[W <br />[]ADDITION ❑ALTEf1ATIUN ❑HCI'M 11 <br />V ALUA710N OF WORK 1 T oy <br />❑DEMOLISH <br />❑FENCE []SIGN ❑';WIMMING POOL. <br />t <br />DESCRIBE WORK <br />_ <br />PROPOSED <br />OTHER PERMITS OR APPROVALS <br />U <br />_c�jK�FC C/ <br />REZONE( SPECIAL USE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />VARIANCE t3 SHORLINE <br />LOT BLOCK —OF <br />SEPA CHECK LIST REQUIRED <br />NE <br />11 YES <br />IZI NO <br />- <br />1 JOB ADDRESS <br />�IQ'-j, <br />'MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY [)(I AS ❑E LF.C. <br />TYPE OF EQUIPMENT FEE <br />._.. - <br />A. <br />F <br />NO. <br />AIR <br />AIR COND. UNI-- -H.P. --- _ <br />Rki RfG RATION UNITS 1_V.. LA _ —�— <br />BOILERS LIP A. ^— 1 <br />FORCED AIP SV STE M•3 A.T.U. MEA. <br />L <br />NO. <br />TYPE OF FIXTURE OR ITEEL <br />FEE <br />HAITUBS <br />S I <br />-- <br />— <br />I <br />CLOTHES WASHER <br />�'I '(-1 <br />I <br />DISH WASHERS <br />SPACE h WALL HEATERS- P.T.U. 1 <br />! <br />DRINKING FOUNTAINS <br />FLOOR DII AI NS <br />I <br />UNIT 1.TE RS tl. T.V. ___ <br />T_ <br />KITCHEN SINKS & DISP. <br />I <br />VA1I SINKS <br />1 <br />EVAPORATIVE COOLERS <br />HOOF DRAINS RAIN LEADERS <br />1 <br />CLOTHES DRYERS <br />—} <br />I <br />—TQAQQ__ <br />SHOWER BATHS <br />Vt,:'1LATION FAN— <br />SERVICE SINKS <br />RANGE NOON_ <br />SUMPS - SEWAGE PUMP <br />-- <br />AIR HANDLING UNIT. <br />— ----'-- - — <br />��� <br />._.._�- <br />URINALS <br />WATER <br />CLOSETS <br />-'- -- — —•-' <br />WATER HE ATE HS - ELECTRIC <br />--- <br />_ _ <br />WATER NEATER <br />- ------•-- '- <br />FAC._BUILT FIREPLACE CHIMNEY_ <br />GAS SYSTEM: NO OP OUTLE IS --{�{ <br />SUn TOTAL_ SI. <br />_�-- <br />'- <br />. - -• -T <br />1 <br />WASH BASINS - - <br />♦, O p <br />LAUNDRY TRAYS <br />. <br />1 <br />-- PERMIT S <br />_ I---- <br />--� TOTAI. FEE 5 /%1 L� <br />SUB TOTAL ' <br />S 9 r'I <br />' " - — "--'-'—`— <br />TIIIS PERMIT UECOMES NUI LAND VOID 11 WORK OH CUNSTRUC <br />PERMIT_ _ <br />TION AUTIIORIYED IS NOT COMMENCED WITHIN 1710 DAY5. OR IF <br />_ <br />TOTAL FEE I -l..) rl <br />CONSTRUCTION On WORK 15 SLRIPI:NDEn OR ABANDONED FOR A <br />WATER SERVICE SIZE_ BLDG. SUPPLY SliJ—K <br />PERIOD OF 170 DAYS AT ANY TIME. AETEII WORK 1!I COMMENCED. <br />I HEREBY CERTIFY THAT 1 HAVE HEAD AND EXAMINI D TIIIS AP- <br />tl!..1. HlRH V; <br />blULYAHUbLILIACKPLICATION <br />AND KNOW TILE SAME TO Ilk TRUE AND COIIRI.0 T. ALL <br />/�,PROVISION <br />7 ILr1_ V F <br />USE ZONE LOT ANLA VACANOR <br />OF LAWS ANU ORDINANCES GOVERNING THIS TYPE <br />OF WORK ILL BE COMPLIED WITH WHET/ER SPECIFICO HEREIN <br />NOT, TIE GRAN;INO ITA PER IT OES NOT Pq ESV ME TO <br />[]YESNOANv <br />GIVE AU RITV TO VIOLATE OR AN L 711E PROVISIONS OF <br />OTHE STATE OR LOCAL W 1!G LATIN(i CONST1(LCTIDN <br />OF H <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF <br />UNITSBILE <br />OR T E E ORMA NCE CO Cl <br />OF BLDG. NO. Of STORIES MA%. O <br />X _ __ SIGNA R CONT OR R U GEIHE <br />Y(7NE ILA..^.kMLNI E1RktiI' <br />REOVIVED <br />�J(, ❑YF7 360 <br />FLAN CIILCK 4! <br />LAN HECK-NUMBERIPT <br />FEE F.I CENNO <br />SPECIAL CONOI TIONS: <br />_ <br />�b �V� LpC�,/�� �' �O 7 <br />/'�/ r L, 1• <br />FEES VALUATION FEE <br />_ <br />BUILDING s 01 <br />SEPA REVIEW COMPLETE: OYES [I NO <br />NO <br />_.._ ..._.r_._ li �bO <br />Contact Plannlnq dept. <br />MECHANICAL .. I ( �•Yl <br />. <br />- - 1 <br />OTHER 1 <br />1 <br />