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CONSTRUCTION c13( y_�� �.-J��_ooc,: <br />PERMIT APPLICATION <br />COMBINATION . BUILDING Is MECHANICAL • PLUMBING <br />own�ul/ <br />MAIL AUURLSS <br />ZII PHONE <br />-04174 <br />A RC HIiLC7 U11 OL51GNL11 <br />MAIL AUORLSS <br />/"ONE LICLNSk <br />GEN`RAL COI�NACiON <br />MAIL AUORLSS <br />PHONE LICCENIiL NO. <br />MECAARICAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMB LNG CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PCRMIT <br />CLASS OF WORK <br />---�-- <br />❑COMOINATION <br />QBUILDING ❑PLUMBING ❑MECHANICAL <br />❑NCW <br />❑ADDITION ❑ALILIIA TtUN [:)III I'Alll <br />VALUATION OF WORK <br />- <br />❑DEMOLISH <br />❑TENCE ❑SIGN ❑';WIMMINII P(IOL <br />S <br />DESCRIBE WORK <br />PROPOSED USE <br />OTHER PERMITS OR APPROVALS <br />jI RE ZONE] SPECIAL USE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW <br />BELOW <br />FOUR <br />F'OURc PIES) _y - <br />Y' <br />OR ATTACR <br />11 <br />�, <br />}-} VARIANCE <br />a t{ SHORLINE <br />LOT OF _ <br />SE PA CHECK LIST REQUIRED <br />1:T YES <br />3ZI NO <br />_ L <br />JOG ADDRESS <br />MECHANICAL <br />,PLUMBING <br />TYI•E <br />OF. ENERGY <br />❑C:AS ❑ELf C. <br />__ TYPE OF EOUIPMENT-_ _ _ _ FEE_ <br />J <br />I <br />• <br />NO. <br />AIR CORD. UNITS-H.P. EA. _ 1 <br />RFF RIDE RATION VNRfS 11 Y. F:A --1 <br />___ —rt <br />DOI(ER$ H.P. EA. - -- -•----•—__L-- 1 <br />FORCEO AIR SYSTEMS B.T.V. MEA. <br />-..-- ---•- --- <br />-_—_. __.___ ___ 1 <br />SPACE & WALL HEATERS-T— <br />UNIT HEATERS H T.U. <br />NO. <br />TYPE OF FIXTURE Oil ITEM j FEE <br />_ <br />— <br />I <br />11 �S �__ <br />SiW <br />ClO7HE5 VJA SHhH <br />C LOl <br />I <br />DISH WASHERS <br />1 <br />ORINrING FOUNTAINS <br />I <br />FI CON DRAINS, <br />KI7(:IIFN SINKS & DISP <br />, <br />HAIR SINKS <br />I <br />EVAPD NATIVE COOLERS <br />CLO T11E5 DRYERS ----_--- <br />L <br />t <br />HOOF DRAINS RMN LEADERS <br />I <br />SHOE\'EH BAIT/S _ <br />I <br />VENTION FAN i T— <br />SFNVICE SINKS <br />RANGE HOOD I <br />SUMPS ._ SEWAGE PUNIP <br />- <br />URINALS <br />AIR HANDLING UNIT C.F.M. <br />_ <br />WAJ E 17 CLOSG.TS <br />WAli II HE ATE ITS ELL'CI RIC <br />R <br />WATER HEATER _ T <br />_ <br />WASll BASINS - <br />, <br />FAC. BUILT FIREPLACE A CHIMNEY t <br />LAUNORY TRAYS <br />GAS SYSTEM: NO OP OUTLI IS T <br />......L- <br />- <br />SVn.TOTAL S I <br />PERMIT .—S <br />PEI1h11T <br />SI <br />P LID BECOMES AND VOIII II WII11K I)H C(V!;, R <br />- TOTAL FEE <br />SI �— <br />lIO A C I <br />ED IS NOt f(Vd•.r1 NCIR 1Oi H (I RO ❑.YY];, OR IF <br />NOT <br />COON CONSTRUCTION <br />CUIJSTIIVCTIDN DR 1YDIIK I!; 'i UI•I`I NOCD D11 AfIANDDNCII FDR A <br />WATER SERVICE SI7F_ BLDG SUPPLY <br />SIZE <br />PERIOD DI 120 DAYS AT ANY TIMI AT TCHWORK ❑:CPMI.IENCtD <br />SIDE YAt(D�LTII U. 1 .- t1ACK <br />NLAH YA{IU <br />I OFAt(IY CERTIFY t11AT I UAVL RLAO ANT) tI YAMINIn T1119 AP <br />SL tUACR` <br />P(JCAI ION AND KNOW THE SAME TO fit TRUE AND CORM CT. ALL <br />PROVISIONS OF 1 AWS ANT) oRnINANCES GOVLIININD 714IS TYPE <br />OF WORK WILL BE COMP(IFR WITH %NIILTHEA-WECIFILD HEREIN <br />USl 2UNL LUl ANLA <br />Vf1CANi SITE �- <br />OH NOT, TILE GRAN7.11f41. OF A PERMIT DOGS NOT PRESUME TO <br />GIVE AUTOORITY TO VIOLATE n14 CANCEL- TIRE f-nOV1910NS Of <br />GIVE <br />❑YES []NO <br />OIIRt.IT STATE Oil LOCAL LAW RL(:ULATINH CONSTRUCTION <br />TYPE Of CONST. OCCUPANCY ONOUP <br />ND.OT -UT <br />On THE PLRFORMANCL OF CONST HUCI ION <br />UNITS <br />SIZE Of GLDG. NO. OF STORIES <br />MAX. OCC. LOAD <br />- <br />_ <br />SIGNATURE__ R OF CON I ACTOR OR AUTII. AG L NT DATE <br />1 lllt Z(lNk IIAGt MLT <br />N <br />IllNINKI 111.5 <br />RLOUIF(L11 <br />❑Y15 ONO <br />•1 ..N LIII CK NUMULII PLAN CIILC), 1 I <br />PLC RECEIPT NO <br />SPECIAL CONDITIONS: ' <br />Y FEES VALUATION FEE <br />_---_ <br />I1llILO1NG i - -- ----I <br />SEPA REVIEW COMPLETE YES <br />' <br />❑ NO <br />PI II MIIIN(1 I <br />conlocl plannlnq dept. <br />MLCRANICAL I <br />0T11[R I <br />1 <br />M\IIAIIpN A\11111U X• \P4)V•IUIU P• <br />UR•AUVIO TUN Y]OAltl l♦ <br />PINALT Y. SEC. 30J I.f 1 <br />TOTAL 1 <br />-al. <br />