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CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING It MECHANICAL • PLUMBING <br />UWNLB .�----MAIL AUUBLSS 21V PHUNL <br />4 4 L4OIs3. Jo ifi-� w 47z4 s wna7 c�z=r _ ' 2 7--47gr- <br />ANC111TECT UII DIGI(:Ni.H MAIL AUUHL55 PHONE LIELNSk NU <br />A GENIfi L^CUNTAWE'll U]fi MAIL AUURESS PHONE LICENSE NU. <br />V- <br />MECHANICAL CUNT RACTOR MAIL ADDRESS PHONE LICENSE NO, <br />PLUMIIING CONTRACTOR MAIL ADDRESS PHONE LICENSE NV. <br />-_---- <br />PERMIT CLASS <br />OT WORK <br />❑COMBINATION <br />BUILDING ❑PLVMUING ❑MLCIIANICAL <br />❑NEW ❑ADDITION ❑ALTEf1A rItIN Ill1•AIII <br />VAW ATIVN OF WJRK <br />00EMOL151/ ❑FENCE ❑SIGN ❑'IWIh1MING FOOT.DESCHIUL <br />S 00=0 <br />WORK <br />'�' tE�as-T I Qei 0--lus(5 <br />PROPOSED USE <br />OTHER PERMITS OR APPROVAIS <br />REZONE 1:1 SPECIAL USE <br />{-y <br />#VARIANCE J--1 SHORLINE <br />LLGAI '1 SC RIPTIDN OF PF40PERTY ISHOW BELOW OR AT TACIT <br />FOUR COPILS) <br />LOT - BLOCK <br />—OF <br />SEPA CHECK LIST REQUIRED <br />`� ILL Lam[ 5 3 (j Le t�-CC <br />I:' YES <br />3ZI NO <br />JOB ADDR SS <br />-7� sta,t*i"T• <br />(MECHANICAL <br />PLUMDING <br />TYPE <br />OF ENERGY <br />Of; AS ❑FLEE. _ <br />----___— <br />-I__ TYPE OF EQUIPMENT FEE <br />• <br />F NO. <br />AR COND. UNIT T5-H_P. EA. <br />RLF RIGS RATION UNITS HP. LA. <br />BOILERS H.P. LA.-•--•---- <br />FORCED AIR SYSTEMS II.T.U.. MEA. �— <br />— --- ---•- -- _ _-1 <br />r— <br />SPACE b WAIL HEATERS TH.T.U. <br />I NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />IIAIH LULLS <br />T <br />I <br />CLO111E5 V!A$111-.H <br />1 <br />DI%H WASHERS <br />I <br />DRINKING FOUNTAINS <br />I <br />I`1 CO IT DRAINS <br />I <br />-� —��— <br />_— <br />`- <br />VNIT 1_EnTERS H T.V. <br />_ <br />1 <br />KIT( '1EN SINKS N I7I51' <br />__ <br />EYnPORATIVE COOL_E145 <br />IMII SINKS <br />I <br />_T <br />CLOTIILS DRYERS <br />HOOF nRAINS RAIN LEAUE(HS <br />SHOT\ER IIATH$ <br />f <br />VENTILATIONFAN <br />SERVR:F SINKS <br />I <br />_ <br />RANGE H000 <br />1 <br />--j <br />SUMPS - SEWAGE PU%IP <br />- <br />AIR HANDLING UNIT C.F.M. <br />WATE-R NEAER <br />-- <br />URINALS <br />WAIER CLOSETS <br />' <br />IIf;AIEIi_ti -ELECTRIC <br />- <br />-WA - <br />- —'TREP - <br />FAC. QUILT FILACE b CIn 61NtY <br />1 <br />_LYAlllt <br />WASHBASINS -- <br />�— <br />i <br />- <br />_ <br />GAS, SYSTEM: NO OP OUTU.IS _ <br />TOTAL 5 <br />._S <br />•, -- __ <br />T <br />-_> <br />--• 1 <br />LAUNURV TRAYS <br />T(/TAI. FEE 5 _ I _ <br />-11115 VF.Hh11T RLCU\iLS NUT L AND VOID II WOIIK TR CUIVSTRUC <br />71ON AUTDOHILLU IS NOT (70%IMLNCI D WTIIIN I]D UAr;;, DR'F <br />CONSTRticrION OR WO IN IU SU!W1 NOED Oil ABANDONED FOR A <br />I'C 11100 OF 120 DAYS AT ANY TIME AF TCRWORK I!.COMIJENCLO <br />SUTOTAL <br />R <br />I <br />- <br />PERMIT _ <br />SiI— I <br />TOTAL FEE <br />51 T <br />WATER SERVICE SITE- BLDC,. SUPPLY SIZE- <br />I IIERFIIY CERTIFY THAT 1 HAVL ItLAV AND FKAklINi0 iIIIS A- <br />PLICATION AND KNOW tHE SAME 10 RL TREK .\NIL C01;RI CT. AL LI <br />•J; +L • CK <br />1,7 IIEET SL79ACK <br />IILAH YARUSL TRACK <br />PROVISIONS OF 1 AWS AND OROINANCES GOVERNING THIS TYPE; <br />OF WORK WILL BE CON%PLICO WITH WILT. THE119VLCIFILII IER1INI <br />USL PONE <br />T <br />LUAHLA <br />VAr-C�ANI SILL ^— <br />AIF OR iCANCEA PET(LI NOT <br />GIVE O VTIIOR TY 701NIG VIOl1MI <br />THE 1-11OV ti ONS OF <br />❑Y E$ ONO <br />ANY OTHLII STATE On LOCAL. LAW IILGULATING ('ON!:TIIUCTION <br />On THEPERFORMANCLOr CONSTRUCTION <br />F <br />T tIE UU� CONST. <br />UCL'UNANCV (: i10UV <br />ND. OF UWLLUNG <br />UNITS <br />l <br />1 <br />kc <br />512E OF ULDG. <br />NU. OF STORItS <br />MA %. BCC. LOAD <br />RACl O110RA IL AGENTn iC <br />III/L ZUNk <br />11.1':1 ML Ni <br />REOUII LD LIIti <br />RLII UIIIL II <br />�' I�L•LN L I I I T NV AIIIL II <br />PLAN L;IIL <br />I:K I LL <br />❑PIS ONO <br />FEES <br />1!C <br />_ <br />VALUATION <br />RECEIVE NO <br />FEE <br />1 <br />1 <br />SPLCIAL CONDITIONS' <br />_ <br />BUILDING <br />3 <br />------ <br />PLUME" Nil <br />I <br />SE PA REVIEW COMFLETE []YES ❑ NO <br />contact plannlnq dOpl• <br />MECHANICAL <br />._ 1 <br />onlEn <br />I <br />1 <br />PENALTY <br />SEC. 707141 <br />_ <br />WRIt IfLKA UM c.LIl yr <br />.uvunl LalU IR <br />ur•vv�wuLl•N,I IT <br />— -- <br />TOTALILE <br />