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CONSTRUCTION <br />PERMIT APPLICATION V1� <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />ONNtN <br />/yM'AILAAUUHLSS <br />LIY YHUNE <br />ARCHITECT OR DESIONER <br />MAIL ADDRESS <br />PHONE LICENSE NU <br />GFNLRALCO TRACTOJI <br />MAIL ADDRESS <br />PHONE LICE SE NU. <br />�''����� <br />�6G'C> 6,1.�P/1Y_C+•(ilf.CG�I <br />�.�.3%/�/ �2f-UI�FU- <br />MECHANICAL CO N.RACTO.1 <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLVMUING CONTRACTOR <br />MAIL AnDRESS <br />PHONE LICENSENO. <br />PEf+MIT <br />CLASS OF WORK <br />❑COMBINATION <br />BUILDING ❑PLUMBING ❑MLCHANICAL <br />_-._..'-_— <br />❑NEW <br />❑ADDItION ❑ALTENA TIf1N Iiyi1L 1•N 11 <br />VALUATION OF WORK <br />L,� <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑RWIMMINO 1.001. <br />S <br />DLSCnIUL WORK— <br />Le �L i <br />> <br />, <br />PROPOSED USE <br />0',H ER PERMITS GRR,APPROVAIS <br />�}•--�1 RL ZONE +-I SPECIAL USE <br />LLGAL DESCnIPTIONOF PROPERTY (SHOW BELOW/• <br />ITTACHFOU <br />vc <br />X- <br />}+VARIANCE L! Sh'ORLINE <br />LOTNCO FILOCKO <br />�OF� <br />' � <br />_ <br />SEPA CHECK LIST REQUIRED <br />.)--I Y E S <br />1:1 NO <br />Ldr <br />JDQI:' � <br />MECHANICAL <br />PLUMBING <br />TYPL <br />OF. ENERGY <br />❑f: AS ❑[EEC. <br />_ _ TYPE OF EQUIPMENT FEE <br />— —t-S- --_— — <br />NO. <br />AIR CONO. UNITS H.P, EA, I <br />__._.. ___ _ ._. <br />REF RIL'ERATION V_NITS NP. En. <br />nOIt ERS IP,[A, ��—��----• <br />FORCED AIR SYSTEMS It. T. V. MEA. -�—� <br />-..___ <br />SPACE & WALL HEATERS B.T.U. T— <br />_ <br />NO. <br />-- <br />_— <br />TV PE OF FIXTURE OR ITEM <br />SEE <br />.� <br />ItA 111111US <br />S <br />_ <br />CLOIHES WASHER <br />I <br />DISH WASHEIiS <br />I <br />DIIINY.ING FOUNTAIN$ <br />FLOOR DRAINS <br />KITCH/ N SINKS & OISP. <br />I <br />UNIT HEATERS N.T.U. <br />I <br />NAIT SINKS <br />I <br />EVAVONMIVE CUOLE RS <br />_r— <br />IIOOF DRAINS RAIN LEADERS <br />1 <br />CLOTHES DRYERS <br />SHOWER BATHS <br />VENTILATION FAN T— <br />SERVICE SINKS <br />RANGE HOOD 1 <br />SUMPS - SEWAGE PUMP <br />-- <br />URINALS <br />I <br />AIR HANDLING UNIT C.F.M. I <br />CLOSETS <br />_WATER <br />_WATEER HE ATEIIS - ELE CT'RIC <br />I <br />WATER h1EATER <br />WASH BASINS - <br />I <br />RAC. BUILT FIREPLACE & CHIMNEY I <br />LAUNDRY TRAYS - <br />�T_ <br />— - <br />_ <br />GAS. SYSTEM NO OP OV 7LF.I5 <br />-- — —"-- .. _sun tOtAL -'5.._ _ _ ....I <br />PERMIT ._S <br />^_ ... _ _ _ <br />SUB TOTAL <br />_ .._____.__.___. T[lTn 1. FEE S I <br />PERMIT_ <br />$ <br />THIS (IMIT L AND VOID 117THIN ON CONSTRUE <br />TOTAL FEE <br />-- I-- <br />A IS NOT <br />TION AV TIIOnIZED IS NOT C(1MMLNUO WIT IIIN 120U.1Y5, OR If <br />AUTHORIZED <br />CONSTRUCTION On WORK IS SUSPI NOCO OR ABANDONED FOR A <br />WA1'E:H SERVICE SIZE BLDG. SUPPLY SIZE <br />PEnIOD OF 120 DAYS AT ANY FIMF AF TEH WORK ISCOMMENCEM <br />UA K I" .,- U CK "LAN YANG SE iBACK <br />I CERTIFY THAT 1 HAVE IIEAO AND EYAMINtn THIS AP <br />LIIIERLIIY <br />PCATION AND KNOW THE SAME TO NE TRUE AND CONNt'. CT. ALL <br />PROVISIONS OF I. AWS AND ORDINANCES GOVERNING THIS TYPE <br />USL LUNL Wl ART .A <br />VnCANT GI'.h <br />OF W611K WILL BE COMPLIED WIT14 WHETHER SPECIFIED HEREIN <br />On NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />❑YES ONO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL TIIE PROVISIONS Of <br />ANY O7HLn STATE OR LOCAL LAW HLGULATINO CONSTIlUCTION <br />TYPE OF CONST. OCCUPANCY GROVI' NO. OF OWE LLING <br />ON THE PERFORMANCE OF CONSTRUCTION , <br />UNITS <br />SIZL OF BLOG. NO. OF STURILS <br />MA %. OCC. LOAD <br />- <br />I"IIIL ZONt �— iM!aML[V1 <br />1t1+1 1•HINKLL115 <br />SIGNATURE Of CON RA C TOH OR AUT11. A[:ENT DATE <br />RF.OUIHLU <br />OYES [INC) <br />PLAN <br />PLAN CHECK NUMBER PLAN CIILCK N:L <br />RECEIPT ND. <br />SPLCIAL CONDITIONS: <br />^FEES VALU:IiION FEE <br />BUILDING S <br />• <br />SEPA REVIEW COMPLETE: OYES ❑ <br />PLUMnINN..._ <br />NO <br />.. _..__._ I <br />contact plannlnq dept. <br />MLCHANICAL 1 1 <br />OTHER I <br />AM LICADONALL(PIIOYI PLANSCNLLKLYYY <br />AMNOO_�VIOT KI@.UANLIYY <br />PENALTY SEC. 3031,1 I <br />+ <br />1 <br />TOTAL i i <br />