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CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />UWNtH MAIL AUUIILSS LIP VIIUNL <br />R N TLCT UTI UC` (:N <br />MAIL AUONCSS <br />PHONE LICLNSL NU <br />GENt HAI CONTEIACTON MAIL ADDRESS <br />PHONE <br />LICk N!:E NU. <br />�e &I told I <._Y 7yi �eQ. .. 3 L'S-3y FU �. 0 -1,33_T� <br />MECHANICAL CUNiRACTUR MAIL ADDRESS <br />PHONE LICENSk NO. <br />V LVMBINOCONTRACTOH MAIL ADDRESS <br />PHONELICENSE NO, <br />PERMIT CLASS OF WORK--� <br />'-- <br />❑COMBINATION <br />❑BVILOING ❑PLUMBING ❑MLCHANICAL <br />❑NEW <br />❑ADDITION LTE IIA t ION ❑HEI-A'H <br />VALUATION OF YJOHK <br />- •---.-- --- <br />S ❑DEMOLISH <br />❑FENCE ❑SIGN ❑':WTMMINt: POOL <br />DLSCHIBE WORK <br />24 <br />PROPOSED USE <br />OTHER PERMITS O{-R. APPROVAIS <br />OP.,CCSIIPTIONOF <br />'tl RE ZONE :�---II SPECIAL USE <br />FLGRL PROPER�%� Y ISHOW BELOW OR ATTACH <br />�T D34 <br />#VARIANCE 1--1 SHORLINE <br />�r <br />„ <br />SE PA CHECK LIST REQUIRED <br />i* YES <br />_( NO <br />JOB ADDRESS <br />// <br />�- C' % r���J %�-✓L L-lt�-<�' <br />MECHANICAL <br />'PLUMBING <br />TYPE <br />OF ENERGY <br />' <br />❑GAS ❑ELE C. <br />_ — _ TYPE OF EQUIPMENT _ <br />NO. <br />_FEE <br />AIRCOND. UNITS-H.P. EA, 'S <br />REFRIGERATION UNITS )I P. EA <br />BOILERS H,P. EA, "_ "•--•---V <br />1 <br />FORCED AIR SYSTEMS B.T.U. MEA. ---�-- <br />NO. <br />TYPE OF FIXTURE OR ITER1 <br />FEE <br />- — <br />_ <br />HAIH TIMS <br />CLO iN E51'lA SH Lfi <br />�— <br />I <br />LASH WASHERS <br />' <br />_ I <br />SPACE & WALL HEATERS - H.T.U. �— <br />DRINKING FOUNTAINS <br />1 <br />FI CON UIIA INS <br />I <br />KITI}IhN SINKS & DISP. <br />I <br />_ <br />UNIT HEATEPS H.T.V. 1 <br />._. --- _ <br />EVAPORATIVE T <br />BAIT SINKS <br />1 <br />HOOF DRAINS RAIN LEADERS <br />1 <br />I <br />CLOTHES DRYERS <br />_SRO\CFfi fL\T 11$ <br />VENTILAT ION FAN <br />SE HVICE SINKS <br />SUMPS - SEWAGE PUMP <br />RANGE HOOD _ I <br />UIOAIALS I <br />_ AIH HANDLING UNIT- C.T.M. <br />_ <br />WATER CIOSL.TS <br />-_ <br />... _ .. _ --' . ..._.._ <br />__-_-- --"-- <br />_WAIEn IB-A7F. Ii5- ELECT HIC I <br />WATER HEATER <br />-,_ <br />WASH BASINS- I <br />_ _ -•�,_ <br />FAQ OUILT FIREPLACE & CIIILINLY I <br />LAUNDRY if1AYS <br />GAS. SYSTEM' NO OP GUILT IS <br />- <br />"SUO TOME $ I <br />PERMIT —S <br />SUE TOTAL T <br />—_-----_— _ TOTAL FEE S I <br />PEI1M_IT__ S <br />THIS PE ii IdIT BCCO KIES Nlll L ANn VOID 11 LVUnA INI f.UNSrRUC <br />TOTAL FEE <br />7ION AUtIIO"IZEO IS NOT C.O.MMLNCT Il WITHIN 10 V.\Y^., OR IF <br />WATER SERVICE S17F. BLOG SUPPLY SI7.E <br />CONSTRUCTION OR WOnK I!; SWO-1 NOED Oil Af1ANDONHI TO11 .\ <br />PLRIOO OF 120 DAYS At ANY TIME AF TEII WOIIK Ht COKIMENCLO. <br />% i �L . LK i L F -UACK NEAR YAHU Ste , <br />I IILRLIY CERTIFY THAI 1 IIAVt HEAD AN C <AMINI n illl i AP <br />PLICATION AND KNOW THE SAME TO Iik TRUE ANO COHHTCT. ALLI <br />PROVISIONS OF LAWS AND OIIDINANCES GOVLIINING 7141S TYPE. <br />U!:L ZDNE LVl AHLA VACANT SITE <br />OF WUHK VJILI. HE COMPLIED WAIT WHETNEn !:PTCIFILH HEREIN <br />OR NOT. III[ GRAN71NG OF A PERMIT DOES NOT PRESUME TOI <br />OYES ❑NO <br />GIVE AUTUORITY TO VIOLATE OH CANCEL THE PROVISIONS OF <br />ANY OTHER STATE Oil LOCAL LAW HLOULATING CONST AUCTION <br />TYPE OECoNST. UCCU PA NCV GROUP NO OF OWLLLING <br />GET THE PLPIFORMANCE OF CONSTRUCTION <br />UNITS <br />SIZL OF OLDG. NO. OF STO Nits MAX. OCC. LOAD <br />x <br />'1'111LZ11TJk IIA(:LMLIVT /INL ):1'IUNK 1.L115 <br />SI G NA T U IT OF CO IN111 A C TO IIO IT A U T 11. A G E N T DI AT <br />Hl0U1/1L 1) u <br />❑Y[S ONO <br />•LAN C11L CK NU MILL II P LAN C I I L I:K ILL <br />EEL" RECEIPT NO <br />SPECIAL CONDITIONS: <br />w YFEES VALUATION FEE <br />BUILDING oz <br />y <br />—' r-- <br />SEPA REVIEW COMPLETE: DYES ❑ NO <br />PLUMBINO <br />contort Planninq dept. <br />—� <br />MLCHANICAL <br />OTITER <br />1 <br />INIK�bUN•L�VIIUYT •'lAY)vlulU •r AMeUY1D U�'.uns.l it <br />- --T— <br />PtNALTY SEC. 3071q 1 <br />TOTAL <br />