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UNC & WASHINGTON 1RUCKING TERMINAL <br />'b 10 34th <br />Sec 29 TWP 29 RGE 05 <br />Rt-5 Ptn Govt Lot 3 Daf Beg SE Car <br />Blk 802 Everett Land Cos 1st Add to <br />COM! <br />�C'AL <br />a i-r <br />Sec <br />29 Twp <br />29 Rge <br />05 <br />Com <br />Se Cor <br />Blk 802 <br />Th N59 09 BOW <br />Alg <br />S Ln Blk <br />7.30 <br />Ft Th 500.51 <br />0OW <br />for 378 <br />Ft <br />`WNEH <br />MAIL ADOHLSS <br />ZIP PHONE <br />A HCHIT ECT UH DESIGNE <br />MAIL AODHESS <br />PHONE LICENSE NO <br />GENE nAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NV. <br />MECHANICAL CONiRACTOfl <br />MA LAV ESS <br />PHONE LICENSE NO. <br />' WMUING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />r <br />VEFMIT <br />CLASS OF WORK <br />❑COMBINATION <br />'BUILDING ❑PLUMBING ❑MECHANICAL <br />i <br />❑NEW <br />❑ADDITION gALTETIAFION ❑11L1'AI11 <br />VALUATION OF WORK <br />- -- -"-"-'-"'-"'---'- <br />S (/J z QE'(,•,� <br />❑DEMOLISH <br />❑FENCE []SIGN ❑';WIMMING 1-001. <br />DESCRIBE WORK <br />WU /V/L tj C'VIP0 <br />Ilv7F' 1%L•r.li <br />PROPOSED USE <br />OTHER PERMITS OR APPROVALS <br />$� REZONE SPECIAL USE <br />LEGAL. UFSCFIIPTION OF Pf(OPERTY [SHOW BELOW <br />OR ATTACH <br />FOUR COPIES) <br />-VARIANCE SHORLINE <br />LOT BLOCK�OF <br />S E PA CHECK LIST REQUIRED <br />f S /il/hc//r 0 <br />Lt YES <br />S:1 NO <br />JOB ADDRESS <br />MECHANICAL <br />PLUMBING <br />'LI <br />TYPE <br />OF. ENERGY <br />T: AS ❑ELF <br />_ _ TYPE OF EOUIPM_ENT _ _ <br />�5_• <br />C. <br />NO. <br />_ FEE___ <br />- _ <br />AIR CONO. UNITS-II.V. E_A. <br />R E F RIG ERAT I ON UNi IS i%v. EA. <br />I <br />--�V <br />NO. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />__... <br />F <br />FEE <br />IiAll{ IIIUS <br />S <br />-_.-_ <br />BOILERS H.P. EA. <br />FORCED AIR SYSTEMS R.T.V. MEA.-� <br />CEO TH 1-i'WASH E I( <br />LUSH VJAYHE HS <br />i <br />_ - <br />_ .. ._.__. ___.._. _._-._. _ <br />SPACE &WALL HE ATF RS B.T.U. <br />_--L._—_ <br />1 <br />U INKING rGUNTAINS <br />1 <br />FI 0011 DI!AINS <br />i <br />_ T-- <br />KII(:HFN SINKS & OISP. <br />1 <br />UNIT HEATERS B.T.V. <br />I _ <br />--T— <br />BAH SINKS <br />1 <br />EVAPORATIVE COOLERS <br />ItUUF ORAIfJS RAIN LEADERS <br />j— <br />CLOTHES DRYERS <br />1 <br />SHOWER BATHS <br />_ <br />VENTILJ TION FAN <br />SEJ{VICE SINKS <br />--- <br />"- --• ' <br />1 <br />RANGE HOOD-- <br />SUMPS -SELVAGE PUMP <br />- --T-- <br />'-- <br />AIRHANDLING UNIT UNIT C.T.M. <br />H CLOSETS <br />i <br />1 <br />_WAIL <br />WATER HEATEIIS - LLE CT RIC <br />_—i <br />_ WATER HEATER <br />WA:;H BASINS <br />- <br />FAC. BUILT FIREPLACE & CHIMNEY 1 <br />LT_LJNDRY TRAYS ' <br />GAS. SYSTEM: NO OP OU_TLI.t_S <br />_-- SUfI TO AL 'S .. .. I <br />—_- <br />I <br />PERMIT S �- <br />--' ---- - - -- <br />SU6 TOTAL <br />i <br />TOTAL FEE 5 1 <br />PERMIT <br />S <br />11117, PERMIT BLCOMES NUI L AND VOID II W)IIK OR CONSTRUC <br />--' 1 <br />TION AUTHORIZED IS NOT COYIMLNCFD WITHIN 1710 DAYS, OR IF <br />TOTAL FEE <br />CONSTRUCTION OR WOnK i!; SUSPENDED Oil ACANDONED FOR A <br />WATER SERVICE SIZE. BLDG. SUPPLY <br />SIZE <br />PERIOD OF 120 DAYS AT ANY (IMF AI'TEI( WOTIK ISCOMMFNCLU. <br />T L •. A' T 'ETUACK <br />HLARYAHUSETUACK <br />I IIERLUY CERTIFY THAI I IIAVE HEAD AND EXAMINID THIS AP <br />PLICAT ION AND KNOW THE SAME 1011E TRUE AND CORRECT. ALL <br />PnOVISIONS OF LAWS AND OIi DINANCES GOVERNING 1111S TYPE <br />U!;C Z"ON6 LU7 ANLA <br />--- <br />VACANT SI:I <br />OF WORK WILL RE COMPLIED WITH WHETHER SPF.CIFILO HEREIN <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTIIOn1TY TO VIOLATE OH CANCEL TILE PROVISIONS OF <br />[]YES <br />❑NO <br />ANY 07HEn STATE OR LOCAL LAW IILGULATINO CONST AUCTION <br />I' I-C OF CONST. UCCL'PANCV (i IiOUP <br />-No —OF DWELLING <br />OR THE PERFORMANCE OF CONSTRUCIION. <br />/-.. <br />UNITS <br />/(/��!'IY%1'7% �•Fj l �`I C'/✓ �S�%%L` O <br />- <br />S12L OF 9LDG. NO. OF STORIES <br />MAX.00C. LOAD <br />lviJ/l• nt/c/c/ rC -71-Y <br />11116 !-ONE '��- IIASF MENF <br />•II HI !:1'111NK Ll�It^ 1 <br />SIGNATURE OF CUNT FACTOR OR `H. G NT DAAC <br />HLOUIHEO <br />❑YES [:)NO <br />PLAN CHECK NUMBLII PLAN CIILCK I LC <br />F'LE IIECEIPT I41 <br />SPECIAL CONDITIONS: <br />T� �I JV !)elk <br />- <br />U <br />Y <br />( <br />FEES VALUATION FEE <br />•~_---- <br />BUILDING i 1 <br />SEPA REVIE\v COMPLETE OYES <br />❑ <br />PLUMBINH <br />i <br />NO <br />..._ <br />contact plonnlnq dept. <br />MLCHANICAL I <br />OTHER I <br />ANKLI(AIHINACLViLUKT YUNi CHILKLUMV <br />AMNUVIU ON Ii'AAIiImy <br />PF.NALTY SE C. 103 (a) 1 <br />1 <br />TOTAL <br />