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- COR�STRUCTION <br />PEf��IT �,PPLIC�,TIOr� <br />COMBINATION • BUILDING • MECHANICAL • PI.UMBING <br />�COM�INATION <br />�OUILDING ❑PLUMBING ❑M6C��nNICnL <br />VALUA�IUN OF WUFK <br />S �'l %,' . C� �� <br />n <br />�p7!3C-J1- BIOCK �� OF �� <br />� <br />�oe <br />AIL <br />>�.�C � '� <br />PMONE � <br />PHONE � <br />PHONE � <br />,�203 <br />J `7���77 <br />- u" <",/ 7 � <br />U. <br />❑NEW ❑ADDITION ❑ALTEtInt1UN..�IU�MH <br />_" � <br />r]DEMOL�SH ❑FENCE ❑SIGN ❑':�VIMMING 1'tlOt. <br />F ATT <br />OTHER PERMITS OR APPROVAw <br />_ .� REZONE $j SPECIAL USE <br />i �.VARIANGE � SHORLINE <br />5 E PA CHECK LIST REDUIRED <br />Lt YES <br />— =j N O <br />MECHANICAL <br />--�� TVYEOF CNEHGY �(iAJ ❑FLEC. � <br />PLUMBING - -- -' ' ---T—'— peE <br />NO. TYPEOFE�UIPMENT t.s_..—.__ --- <br />_ _'_' '_'___ _ __ <br />. ... -�__'— � <br />ai r+ eo no. v w r s-��. v. e n. _. ...___—.-_ ._---r-- <br />.____---- --- <br />FEE REfRIGEPATIONUNifS H.V.L4. `_""_^_____L_� <br />NO. TVPE OF FI%TURE OR i_iEM _ _ __. .___ --- -- ��-�-'-- ; <br />--- -- -- j ... OOIItfi$ H.� EA. � <br />1{A 1 H I 11:1:i � _ -.. . _ . - _-•--"----T.-- <br />(;�O�HES Yll1SHEN FU�CED nIR 5�57EM5 ❑.LV. MEA. y___� <br />UItiH W�SHEItS � — -'� __'___ --- 1 <br />I . t_�_ <br />Df11NY.INCi FOUNTAINS ___ � -- <br />SPACE !L YIAII HEATENS - O.T.V. ' <br />FLCOH 0{IAINS � - --" —__ <br />� VNIl HEATERS H.T.V. ..--T--- <br />KIT4:HhN tiINY.$ Cv UIS{'. EVnPORnTIVE COOlERS '___'__'�" 1 <br />unr� sir�r's ' ------'------- i <br />—r-- CLOTHES DRYER$ _�-- <br />IICOF DNNtJ$ FiAW L@AUCR$ � _ --�- --'-- ' <br />SH0ICEHHATHti _ VEN71LnTIONFAN l- <br />� RANC.E 11000 � <br />�;cHviCE SiNY.S --' ----�—T-�- <br />_- — __ -_ <br />SUMPS - SEtYAGE PUMP Alfl MANDLINC VNIT Gf_M_.._. ._...___'._1-�- <br />' � <br />"____�_ _... .�_"_ _.__�._ "_.... <br />UHINnLS ' . _ __._ . .... ._. ._.T_..- <br />i. .. . .._._ .. .. _ <br />WNENClO5f75 .._ WATEHHEATER_ . . . .._t... .' "1---- <br />WATEFl HESAT[II$ . FLLCTRIC FAQ flUILT FIREPLACE t4 C111t.1NEY .. . --.-- �__,, <br />-.- "'- '"_' _ ' -T <br />WASH EiASINS ' i _ ' ' .-"' .-'.. _. _ .. - � '-- <br />_._ ._. <br />__ GAS. SVSTEM1�� NO OP OUTLl.1 _ ..4 <br />..__ .... . .. .. . <br />LAUNDFiY IRAVS _ -- "' _.. ._. SU� TOfnl 5 __""'_'�� <br />� --' - �� PERMIt S <br />" __""_"_'__...__ __ <br />-' ' _'."___"�-___-_ ' TOTnI.{FE 5�.___"_'.�___ <br />�_"". . _ _ .__.�." <br />— SUO TOTf.L � T1115 YF.Hh11T UECOMES NUl l �NO VOII) 11 WU1�1: UH CUNSTltUC <br />PEfIMIT S _ TION AU�IIURIZ@D IS NOT COh141LNC(D \VITIIiN 1?0 D.1V!:.Oli iF <br />TOTAL FEE � VL�lIIOD'Of-r1�0,0AVSVA�T ANl'�f��Mt� /�F fE1t�1VOf1�K �J CIyC�`!F.NCEU. <br />WAT[R SF.RVICE SVF dlDG.SUPPLV SIZ.E__ : ����q611V C[RTIF�' T��n� � iirtvE nLnU nNn C<I�A!iNtP r��i: n� <br />T� i� t �t � .,' UACK HhAH vAHO5E7UnCK. PIICATiON AND KNOtY THC SAh1E TO Ilb TfiVE �\NO CORIIE CL ALL <br />Pf70VISIONS OF LAWS /1NU OIIDINANCE$ GUVEfiNING ����5 TYPE <br />Of WO��K Y�iLI BE COM1�PL�F.O W�iM W��ETMEfi ::NECIFIEU �1EHEIN <br />LU7 A���n Vl1CANT :RF T_� UF NOT, T��E GAAN7ING OP A NERMIT DOC$ NOT PPESUh1E T� <br />U:il ZUNL (i1VE AUT�IOfiITY TO VIOLAfh OH CANCkL fNE PqUVI$iON$ Of <br />❑YE; ❑NO �. AN� OTHhR STATE OR IACAL LAW IIIGULl�TW(i CONtiT11UCT�0� <br />TYFE OF CONST. OCCUPANCV (iHOVv NU.OF OWhIUNG <br />On TME PEfiFi FMANCE Of C(JN51 NUL'l ION' <br />VNIT$ , . � '. _ .� <br />5�2E OF UIDG. �10. OF STORIES MA%.00C. IOAD j x I�) j r/.��. ' ��/��� 1C 2 'l___� <br />.. "c�r.renr/iiufOf�RACl0ftd9l�UTII nGENT I�ATF __ <br />L CO>1DITION$' <br />� -- - <br />I SEPA REVIEW COMPLETE � <br />� contacf planninq dept. <br />iEU <br />.. ❑NO <br />❑YES ❑ NO <br />. _ __._'.FEES –.._' <br />11UILO�NG <br />ri�iMniN�� <br />MlC11nNICAI <br />OTIICN <br />•nuuhaw�c�Vuu�r V�NiLNIlF1UYY' I.MNOVIO a��sw��l�r PENAITY <br />�� ' TOTAL <br />-- YLANCIhCA � Lc <br />{LC IIIECEIPiNn <br />ION I FF.E <br />—__�–_._ _—_f _ <br />S � <br />------- --- <br />-- �---.._. r---.. <br />i <br />i <br />. i <br />1.. _. . <br />i <br />I <br />—�'_T_ <br />SEL. ]071�1 � <br />_ . .. ; <br />—' _'... _ _�- . - 1 <br />I <br />