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COINSTRUC-( ION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL <br />PLU MBING <br />/z/z 9171 <br />?77d <br />uW l MAIL AUUHESS ZIP PHONE <br />1 AgCHITECi UN DLSIfiNEH MAIL ADDRESS <br />1 <br />PHONE LICENSE NU <br />'GEN� jCONTRACTO,fR MA_IL/%DDRESS PHONE LICENSE NU. <br />S ui✓, r l:�?, <br />-3 Lam/ &1-41- c a 37z <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAILADDRESS <br />PHONE LICENSE NU. <br />PFEnwT <br />CLASS OF WORK <br />tacc;MBINATION <br />[]BUILDING ❑PLUMBING ❑MECHANICAL <br />❑NEW <br />❑ADD$ TIUN AALTEHA PION ❑HLI'nn1 <br />-rJ7A OF WORK <br />S <br />❑UE MO I S H <br />❑FENCE ❑SIGN ❑'IWIMMING POOL <br />D ESL E WURK <br />PROPOSED USE <br />OTHER PERM -ITS OR APPROVALS <br />^ REZONE SPECIAL USE <br />LEGAL DESCRIPTION OF PROPERTY <br />(SHOW BELOW OR ATTACH <br />FOUR COPIES$ <br />t$VARIANCE III SHORLINE <br />LOT BLOCK —OF <br />r <br />SEPA CHECK. LIST REQUIRED <br />c F'� 3 F <br />1-1 Y E S <br />3ZI NO <br />JOB ADOn SS <br />�36 •-�C•� •�/l it r S jT� <br />' MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑f:AS ❑FLEC. <br />_ _ TYPE OF EOUIPMENT _ _ _ _ FEE <br />�5 <br />NO. <br />AIn COND. UNITS-H.P. EA. 1 <br />qkF nIGE RATION UwfS H.P. EA. —_—? <br />BOILERS H.P. EA.�- <br />1 <br />FORGED AIR SYSTEMS_. B.T.VMEA. -�--�— <br />1 <br />SPACE & WALL HEATERS H.T.U. T— <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />- <br />— <br />HAIH TAUS <br />CLOTHES WASHER <br />I <br />UISl1 WASHERS <br />DRINKING FOUNTAINS <br />i. <br />F10OH DRAINS <br />I <br />SINKS & DISP, <br />I <br />UNIT HEATERS' B.T.U. <br />1 <br />_KITCHEN <br />IIAR SINKS <br />I <br />EVAPORATIVE COOLERS <br />HOOF DRAINS RAIN LEADERS -—i <br />CLOTHES DRYERS <br />1 <br />SHOWER HATHS <br />VENTILATION FAN T� <br />SERVICE SINKS <br />I <br />RnNGE HOOD 1 <br />SUMPS .. SEWAGE PUMP <br />URINALS 1 <br />_ AIR IIANDLIhr. UNIT C.F.M. •.___ <br />WAI E11 CLOSB,TS- <br />_ <br />�-C--- � -'- - <br />WATER HF.'ATE115 -ELECTRIC I <br />WATER HEATER <br />.__ _. ... <br />LVASH BA$IIJ$ I <br />FAC. BUILT FIREPLACE A CHIMNEY 1 <br />LAUNU Y -RAYS <br />—__ T-- <br />_ GAS SYSTEM: NO OP OVTLI iS <br />- _._5 <br />•_ <br />SUIT TOTAL I <br />PERMIT .-5 <br />S _ I <br />PERMIT $ <br />—� <br />MIS PF.F MIT UECOMES NUI 1. AND VOID 11 WORK OR CONSTRUC <br />7I ON AUTHORIZED IS NOT r0'4MENCID WITIIIN 170 DAY!:, OR IF <br />TOTAL FEE S <br />CUNST IIUCTIDN On WORK I , SV:P9'NDEO OR AOANDONEO FOR .Y <br />NATER SERVICE SIZ[ BLDG. SUPPLY SIZE <br />PERIOD OF 120 DAYS AT ANY fIME AFTER WORK IS COMMENCED, <br />li d A 7( TRACK HLAH YAROSE$HACK <br />1 1:1 RLIIY CERTIFY THAT 1 RAVE REAL) AND EYAMINin T1115 A- <br />L CAT I(IN AND KNOW THE SAME TO RL TRUE AND CORRI CT. All <br />PROVISIONS OF LAWS AND ❑nnINANCES GOVERNING THIS TYPE$ <br />U::L 70Nk LU7 AHLA VACANT SITE <br />OF WORK WILL BE COMPLIED WIT$/ WHETIIEn SPECIFIED HEREIVI <br />OR NOT, TIIE GnANTING OF A PERMIT DOES NOT PRESUME TOI <br />' DYES [:]NO <br />GIVE AUTIIOnITY TO VIOLATE OR CANCEL TIIE PROVISIONS OF <br />TYPE OF CONST. DCl'UPANCY GIGROUP KO OF DWELLING <br />ANY OTHER STATE OR LOCAL LAW I ILGVLATING[10NSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />UNITS <br />F <br />SIZE OF BLDG. NO. OF STORIES MAX. OCC. LOAD <br />X <br />111•/LZOtJ! jlA:fk ML[JI IIi1E til'IHNK Ll11.5 <br />SI(:NATUnEOFCONTRACTORORAUT//.AGCNT DATE <br />REOWHLD y'LANCII <br />- ❑YIS ❑NO <br />ILCKNUA11ILH I'LANCHLCKFLL <br />ILC IICCEIPT NO <br />SPECIAL CONDITIONS: <br />FEES VALUATION FEE <br />BUILDING i 31000 / IC <br />_l <br />• <br />SEPA REVIEW COMPLETE ❑YES ❑ IJO <br />rurLlm Fln <br />!••-_ i <br />contact Plannlnq dept. <br />MLCIIANICAL i <br />OTHER 1 <br />1 <br />PYUURUN/.lU(11UYT •I+IwYlM1�uUYv —�, *OYIpT1 YY <br />PENALTY SEC. 307(11) <br />_ L-- <br />TOTAL <br />r, <br />