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- CONSTRUCTION <br />PERMIT APPLIC,�TION <br />�P///,,1 <br />3�, li'y <br />COMBINATION • BUILDING • MECHANICAL 0 PLUMBING <br />GENL RAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />LICENSE NO. <br />MECHANICALCONTRACfOR. <br />MAIL ADDRESS <br />PHONE <br />PLUM BITIO C 0 NNTRACTOH <br />MAIL ADDRESS <br />PHOIJE LICENSE NU. <br />PERMIT <br />CLASS OF WORK <br />, <br />❑COMBINATION <br />❑QUILDING ❑PLUMBING []MECHANICAL <br />❑NEW <br />CIADDITION ❑ALTERATION- ❑HLI'AIR <br />V ALUATION OF WOO L _ <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑SWIMMINII POOL <br />5 <br />DESCRIBE WORK <br />OTH ER PERMITS OR APPROVALS <br />PROPOSED USE <br />.11 REZONE tj SPECIAL USE <br />LLGAL OLSCRIPTIUN OF PROPERTY ISHOW BELOW OR ATTACH <br />FOUR COPIESI <br />VARIANCE �? SF'ORLINE <br />�a <br />LOT f r BLOCK'OF " <br />5 EPA CHECK LIST REQUIRED <br />= YES <br />NO <br />JOB ADDRESS <br />a'7 g jt%/ T- Gs. tTT ich I'2� <br />'MECHANICAL <br />TYPE OF ENERGY F.C. <br />❑r,n5._ ❑ EL_ <br />PLUMBING <br />..___ <br />TYPE OEQUFEE <br />NO. F _ .. _...IPMENT <br />s. <br />AIR CONO. UNITS- I.P. E <br />NO. TYPE OF FI%TUBE OR IT:fA <br />FEE <br />_A. <br />— REF RIDE RArtotJVNIrS 1_. N, Cn. __�__ ; <br />-- <br />14Ai11 TUBS <br />S <br />I <br />001L E.RS H.P.EA. _ <br />FORCEO AIR, SY 57EMS (1__T,V_ME <br />CLO TN ES WASHEH <br />4 <br />1 <br />DISH WASHERS <br />1 !J <br />r_— <br />___ <br />OHINKING FOUNTAINS <br />1 <br />SPACE &WALL HE AiERS <br />Ft OOH OHAINS <br />I <br />"-- 1 <br />UNIT 11EATE RS_-1-- <br />KITCHFN SINKS & UISP. <br />�I <br />EVAPDRANATIVE COOLE14S <br />IIAII SINKS <br />ABBE DRAII:S RAIN LEADERS <br />—J CLOi11E5 ORVERS <br />VENTILATION FAN CO <br />SHOWER BATHS <br />_SERVICE SINKS <br />-�_ <br />RANGE HOOD __ —,_— r <br />C. T.M1I. <br />SU(__IPS - sr AGE PUNIP <br />, <br />AIR ILA HOLING UNIT _.- <br />U I11141, LS <br />I <br />'EAT <br />VJKI F. 11 CLOSC_TS <br />- - <br />WATER R_. _ ---1--- <br />_ <br />WA1L(1111SATF.115 ELECTRIC <br />DASINS <br />I <br />I <br />.HEnTE <br />" pAC. BUILT FIREPLACE W D111 M11N EY 1 <br />_ _ _._ ..-Z-__._ <br />I I. 15 <br />WASH <br />OILY fiAYS <br />LAUN T <br />_ -GAS.. SYSTEM.. N_0__O_P OU <br />—� DUB TOTAL-5 - Iov <br />— <br />•---'-��- <br />-- <br />PERMIT S _�_Q <br />L <br />SUB TOTAL <br />I <br />THIS VF. (i h1iT BECOMES NUI L AND VOID II WUII1; Of� C<)N..T RUC <br />4Y IT IIIN I?O DAY';, On IF <br />PERMIT <br />S G <br />TION AUTIIOHIZED 15 NOT COMMLNCIO <br />n FOR <br />OCOMMENCED. <br />IATt <br />TOTAL FEE <br />S� �T' n0 <br />PERIOB or 1O0 DAYS ANY�TI,M[ AF TE11)WORK I:'.il <br />YATEn SERVICE SIZE BLOG. <br />SUPPLY SIZE <br />I RERERY CERTIFY THAT I HAVE HEAD ANC EVAt.•INI D THIS AP <br />OMT'Y� N '5TTAZTrU YUACK <br />Y'AHUSLIBACK PLICATION AND KNOW THE SAME TO IIL TRUE AND COi;W CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING 1141S TYPE <br />OF WORK WILL BE COMPL IE0 WI I it WHET HER:;PE CI F IEI) HE HE IN <br />PERMIT OOES NOT PRESUME TO <br />JSI. ZONE _ - LO7 AIILA <br />OR NOT. TILE GRANTING OF A <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of <br />LOCAL LAW ItEGVLATING CONSTIiUCTION <br />ADWLLLING <br />ANY OTHER STATE Oil <br />O11 THE PERFORMANCE OF CONSTRUCTION, <br />TYPE DF CONST. DCCUvlaNCY G((VUP <br />ULDGO. OF STORIES <br />^i1ZEOF / ! (/••� / / <br />xU <br />rot <br />SIGNJ�'7••U�/IIEO4CNTRACTO- F1,]O�RA-UTt I/(. nGl'NT <br />'II/E ZOfVL IIA1:F Ml NI <br />/ IIIL'.:I'N INK, L11.5 <br />RLn VitR.D <br />LAN CHLCK NUMOLII VIAN CIIL I'K t-LL <br />IS ONO <br />ILE IfECE1PT NO. <br />�/ <br />;PLCIAL' CONDITIONS: <br />._ „ •. -^ FEE <br />^- <br />FEES _ VALUATION _-FEE <br />- I <br />BUILDING <br />BUILDING sL_'>COU/ <br />v <br />SEPA REVIEW COMPLETE; OYES <br />c ❑ NO--••__ <br />' PLUMBING L <br />�i 00 <br />contact Planninq deft. <br />MLCHANICAI L__..... <br />I <br />' <br />OTHER 1 <br />nRKIt LICAOH L1lU YY. rU.n; LnLL.IU eY. <br />Ah•.UV10 Un INU.nLI <br />• SEC. 0001.) <br />YY PENALTY __^.•—,—��••,-„L„�—. <br />II <br />1 <br />TOTAL O O <br />