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CCNG TRUC T ION <br />PER1,AT /-'\PP .ICAT ION <br />COMBINATION c BUILDING o rAECIIAN'::AL . PLUMBING <br />UW bLfI MAIL AUUI ILL'. LIP PHUNL <br />1�(J h� fa7 i (u. --5 ao-3 <br />ANCHiTLCT Oft DESIGNER MAIL ADDRESS <br />PHONL LICENSE NU <br />G_ENLRAL CUNT HACT R MAIL ADDRESS <br />PHONE LICENSENU <br />I <br />EC ICAL CONTRACTOR MAIL ADDRESS <br />PT10NE LICENSE NO. <br />PLUMBING CONTRAC TOR MAIL ADDRESS <br />PHONELICENSE NO. <br />V[FIMIT CLASS OF WORK <br />—«— <br />ffCOMBINATION <br />IQ BUILDIN7 ❑ PLUMBING ❑ MLCl/ANICAL <br />❑NEW <br />❑ADDITION'AL TEIIAfNON IICI'Alll <br />VAL TIOjJO Or,— <br />SA <br />6 6 ❑DFMOL.SH <br />7L5r <br />NCE ❑SIGN ❑SIYIMMIN41•fIOL <br />IDE CRC HIDE ORl.�K <br />iPROP05 usE <br />OTHER PERMITS OR APPROVALS <br />T3 RE ZONE 1:1 SPECIAL USE <br />LLGAL DESCRIPTION OF PROPERTY SSHOW ELOV OR ATTA��ggH <br />FOUR�CpOP�I�E51 <br />����JJ •?i-VARIANCE <br />SHORLINE <br />LOT � BLOCKL OF —La�) <br />— <br />5EPA CHECK. LIST REQUIRED <br />.L-t Y E S <br />L <br />( <br />JOB ADDRESS <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑OAS ❑ELf. <br />TYPE OF EQUIPMENT _ _ <br />�S <br />C. <br />NO. <br />_ FEE__ <br />__ _ <br />AIRCOND. UNITS-H.P. E_A. <br />ntf RIDE RATION UNI FS H.P. En. <br />OOII FIRS H.P. EA.--_•-�_---_ ��---1--- <br />FORCED AIR SYSTEM.: B.T.U. ME A. <br />---^ --^-' --- <br />SPACE_& WALL HEATERS- B.T.U. <br />I _ <br />NO. I <br />TYPE OF FIXTURE OR ITE(.7 <br />FEE <br />RA1H TDL.i is <br />— <br />---------•-_.__._ <br />— <br />I <br />CLOTHE.`: WASHER <br />I <br />--�_ _ <br />DISH WASHERS <br />I <br />. 1 <br />BRINGING FOUNTAINS <br />1 <br />T-- <br />_ <br />FIOOH OIIA INS <br />1 <br />I KITCHEN SINKS & UISP, <br />I <br />UNIT NEATENS B.T.U. _ <br />-,�_- <br />IIAIiSINKS <br />I <br />EVAPORATIVE COOLERS <br />I40C1F DRAINS FiA1N LEADERS <br />�— <br />CLOTHES DRYERS <br />I _ <br />SHOWER IIATHS <br />VENTILATION FAN <br />SERVICE SINKS <br />RANGE HOOD <br />—� <br />I <br />SUMPS SEWAGE 1'Uh1P <br />.. <br />A IH HANDLING UNIT C.F.h1. <br />_ ..___. .__.... ___. ._ _...__. <br />..._ _.T- <br />_— <br />LOHINALS <br />1 <br />_ <br />LVATEA CL.OSCT$ - <br />1 <br />- ----"—'�--- <br />W-A7Eii HE ATEHS - ELECI'R IC <br />..._ <br />WATER HEATER <br />_. <br />FA C. BUILT ILT FIREPLACE_& CIIIh1N_ EY <br />_ ... __ <br />GAS. SYSTEM: NO OP OUTLE.IS _ <br />._. .....SUB To FAL ._5. <br />1 <br />�T <br />... _-.. L— <br />.. ..__ <br />I <br />LAUNDRY TRAYS <br />. <br />1 <br />—'•--- T[.ITnL FEE 5 I <br />SUR TOTAL I <br />THIS PERMIT BECOMES NOT 1. AND VOID It WDIIK OH CONSTRUC <br />PERMIT __$�� <br />TION AUTIIORNZED IS NOT C(1MMLNC(D WITIBN 170 CAY!:, On IF <br />TOTAL FEE i• <br />CONSTRUCTION OR WONK Ilf SUSPI'NDED On An ANDONED FOP A <br />WATER SERVICE S17F. BLDG. SUPPLY SIZE. <br />PERIOD OI' 170 DAYS AT ANY TIME AF TER WORK II: COMMENCED. <br />I IIEREIIY CERTIFY THAT I IIAVE HEAD AND E•(AIINIn THIS AP <br />41t >L ALn R BACK lit AH YAHU SE iBAGK <br />PLICATION AND KNOW THE SAME TO IN, 7NUE AND COIIIi I'CT. I.I. <br />PROVISIONS OF LAWS AND ORDINANCES DOVE FINING THIS TYPE, <br />OF WORK WILL BE COMPI.IEO WIIH W11F.TIIEII::PECIF ILD HE RE I% <br />^— <br />USl ZONE _ LUt AHLA VACANT SITE <br />OR NOT, TINE GRANTING OF A PERMIT OOES NOT PRESUME TOI <br />GIVE. AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />' OYES ONO <br />ANY OTf1En STATE On LOCAL LAW IN GULATINti CONSTNUCTION <br />TYPE UE CONST. OCCUPANCY GROUP NO. OF OWL LLING <br />On THE PERFORMANCE OF CONSTRUCTION ' <br />UNITS <br />SIZE OF BLDG. NO. OF STORIES MAX. OCC. LOAD=/)-ry(f <br />A <br />SIGNATURE OF ACT OIIO RA U T 14. A G L N T DTE <br />111k ZONE IIAaI MLNT IIH!':I'111 NKL iW% <br />FHOUNILE) ...i'LnN <br />DYES ONO <br />C11LCKN MIIR I'LAN CIIL CA ILL <br />ILL NCCEIPT NO <br />SPECIAL CONDITIONS- <br />^ <br />FEES VALUATION FEE, <br />1 <br />-- <br />BUILDING 5...__.--_.__.__ — .��r <br />SEPA REVIEW COMPLETE ❑YES ❑ NO <br />PL IIMII1N11 '--- 1 <br />COnlacf Planninq dopt• <br />MLCIIANICAL <br />i.._._. <br />- - •- <br />I <br />OT71ER 1 <br />Wl IVA I NA ALL I t I lUY1 L III LAI. YV AMMl 111RI7 N'AlK1 YY <br />1'PNALTY +EG'JB.I Id^ L-- <br />111III <br />F <br />TOTAL I <br />