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- CONSTRUCTION <br />PERMIT API LICATION <br />COMBINATION • BUILDING • MECHANICAL <br />PLUMBING <br />370 Y <br />ZIP -_--- PHONE <br />//// <br />P,/��.� <br />T <br />Afi�H1T DESIGNER <br />[CT7UR MAIL ADDRE55 PHONE LICENSE NU - <br />GEN-AL CONTRACTOR MAIL ADDRESS PHONE LICENSE NU. <br />MECHANICAL CUNTRACTUR MAIL ADDRESS PI(DNE LICENSE NO. <br />PLVMUING CONTRACIOH MAIL ADDRE55 PHONC LICENSE NU. <br />I'L RMIT <br />CLASS Of WORK -� <br />❑COMBINATION <br />- <br />®GUILOING ❑PLUMBING ❑MECHANICAL <br />- <br />ppNEW ❑ACOITION ❑ALTEfA fl(IN ❑.{I1'A11 <br />VA_U-AT-I.ON OF WOHP <br />--------• --- <br />--) o <br />$ <br />❑DEMOLISH ❑FENCE ❑SIGN ❑:WIMMIN(: POOL <br />DESC/HTIOE WORK _ <br />LCC)o17 o Vr2 Poll <br />PROPOSED USE <br />O1HE{;PERMITS OR APPROVALS <br />-� REZONE SPECIAL USE <br />LLGAL OLSCnIPTION OF PROPERTY (SHOW BELOW OR <br />ATTACH <br />FOUR COPIES) <br />VARIANCE }y <br />LI SHORLINE <br />LOT BLOCK-�OF <br />' <br />E PA CHECK LIST REQUIRED <br />I:' YES <br />rj N O <br />7oH v6bwcis <br />MECHANICAL <br />PLUMBING <br />- <br />YPLOfENERGY <br />❑rn ❑ELEa <br />_ _ TYPE OF EQUIPMENT - —�s <br />- - FEE <br />NO. <br />r <br />AIR CDND. UNITS-ILP. LA. <br />REF OfIG ERAT ION UNI fS II. P. CA. <br />---------�-'+ <br />)— <br />N0. <br />TYPE OFFIXTUH E Oft ITEM - <br />FEE <br />OATH 1OBS <br />SHP.EA. <br />— <br />CLOTHES f-H <br />1 <br />FORCED AIR SYSTEMS H.T.U. MCA. <br />. •---__. __. _. ___ <br />SPACE A WALL HEATCnS •. H.T.U. <br />-T <br />E[511 <br />DISH YJASHF: R$ <br />1 <br />' <br />DRINKING FOUNTAINS <br />I 00H UIIAINS <br />1 <br />�- <br />_KITI:IIhN $INK$ & OISP. <br />1 <br />UNIT IIEA7"ERS H.T.U. <br />I <br />❑AII SINKS <br />-- <br />1 <br />-- --- <br />FVnPONATIVE COOLL HS <br />- T <br />ItO(]F OR It, RAIN LEAOC-RS <br />�T_ <br />CLOT11E5 DRYCRS - _ ------ <br />-�- <br />SH01YhfiHATHSVENTILATION <br />F AN <br />n-- <br />nrace Hoop <br />T <br />T— <br />I <br />SE Ii VICE SINK$ <br />- SEWAGE PUMP <br />_SUA1P$ <br />URINALS <br />AIR /1ANOLING UNIT <br />LYA7P.R CLOSEJS <br />1 <br />�- <br />L'!!\l Lfi 11F. ATEIIS ELECIRIC <br />_ <br />_ <br />WATCH IIEAT_E R-- _- - •- -••-__ <br />FAC. BUILT FIREPLACE ti CHIMNEY <br />GAS�51'STC M� NO OP OUTLI.IS <br />..--SUn TOTAL S <br />- _~•�_ <br />-1--_ <br />I <br />- - r_ <br />1 <br />' <br />l'JASH BASINS - <br />1 <br />LAUNDRY TIIAY$ _ <br />PERMIT <br />—_�---_----TOTAL. <br />SUR_IOTA L <br />T <br />FEE S __ 1 <br />1111S PEllllll ULCOMES Nil] L AND VOII] If WORK 13" CONSTRUC <br />LION AUFIIURIZGD IS NOT C(]MMINCEO WIT111N 120 DAYS. OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED O11 ABANDONED FOR A <br />PCRIOD OF: 120 DAYS AT ANY IIMF AF FtJi WOnK MCOMMENCEU, <br />1 IILRL0Y CERTIFY TIIAT I IIAVC IILAD AND CSAMINID TI115 AP <br />PERMIT <br />S — <br />- <br />TOTAL FEE <br />--f <br />[ <br />VATER SERVICE SIZE RLDG. SUPPLY SIZE <br />1 A. uL l' LK <br />it 1lU.CK HI:A <br />I3 YAHp yL Ti]gCK <br />PLICATION AND KNOW TILL SAME TO III, TIIUC AND COIUI("CT. ALL <br />PROVISIONS OF LAYS AND OHD{NANCLS OOVEfINING 11115 TYPE <br />LUT AIILA VACANT <br />OF WOIIK WILL BE COMPLIED Willi WHCTHEH ::PECIFIEU HEREIN <br />OR <br />- <br />SITE '�—i <br />NOT, TOIL GRANTING Of A VCHMIT DOES NOT PRESUME TO <br />' <br />❑YCS ONO <br />GIVE AUTIIDRITY TO VIOLAIL OR CANCEL TILE VnOVISIONS Of <br />ANY OT11F.R STATE Off LOCAL LAW IILGULATIN G CONSTRUCTION <br />01% THE PERFORMANCE OF CONSTIIUCI ION. <br />TYPE OF CONST. <br />OCCUPANCY ❑RUVP ND. <br />OF D,L LUNG <br />UNITS <br />/ <br />i1ZC OF BLOC. <br />NO. OF STORIES MAX, <br />OCC. LOAD <br />'lll6%ONE <br />IIA;[ML&if I <br />lit LSI'Ii1NK 1. LH,5 <br />51GNATUR fCONT nALTOFIOH AUTI/.AGENT GATE <br />li <br />C 011IRCU <br />�-1\'1 5 ❑NO <br />L <br />'LAN Ct� IL CK NUb111LH <br />_ <br />PLAN CIILCK FEL <br />I—LL <br />1 LL' LIE CEIPF N(\ <br />SPECIAL CONDITIONS: <br />�-- <br />FEES <br />VALUATION FEE <br />IIUILDING <br />1 <br />�_ <br />f <br />-- -- <br />SE PA REVIEW COMPLETE OYES ❑ NO <br />PLUMHINn <br />contucf Plonnlnq dBPt. <br />fd[CIIANICAL <br />j <br />OTIILR <br />1 <br />I <br />nil"110NILLHIIu YY'. MlANS[+14LW eY: eF1•eDVIplOe u.Lleu(1 YY 1 <br />PENALTY <br />SCC. 30014) <br />1 <br />TOTAL —� 1 <br />�- Z j •� <br />