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CONSTRuc,riON <br />PERMIT APPLICATION <br />COMBINATION • BUILDING a MECHANICAL • PLUMBING <br />UWN i/ <br />MAIL AUUIIL" <br />LIP PHUNL <br />p �j <br />Pf <br />d'1J`-` <br />OL51 G NEH <br />MAIL ADDRESS <br />PHONE LIC ENSk NU <br />GENE.ALCONTnACTOfi <br />MAILADDRESS <br />LICENSE NU. <br />ulill�i•A.e1�1./? ®/!// -J�� <br />/!J�/f <br />/PHONE <br />�J �✓�-'���5 �J "JNI O- - _ � <br />MECHANICA U TRA O <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NU. <br />;PERMIT <br />CLASS Of WORK <br />' <br />❑COMOIN ATION <br />: ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL <br />❑NEW <br />❑ADDITION ❑ALTERATION 0HEPAIFI <br />VALUATION OF WORK <br />❑DEMOLISH <br />-v _- ------ <br />❑FENCE ❑SIGN ❑SWIMMING POOL <br />S <br />DESCHI LWORg <br />f <br />/� l <br />PRDPOS USE <br />�� OTHER PERMITS OR APPROVALS <br />_ <br />, <br />j ( RE ZONE SPECIAL USE <br />��s2t111L.�l�l <br />LEGAL DVSCHIPTION OF PFWOPLFrry (SHOW <br />FounCOPIESI <br />'LOW OR ATTACH <br />1 <br />MVARIANCE El SHORLINE <br />LOT / BLOCK —OF <br />-� <br />SEPA CHECY. LIST REQUIRED <br />O-19,7) <br />]� YES <br />� <br />_ <br />]� NO <br />JOB ADDRESS <br />-- -J L <br />n <br />MECHANICAL <br />PLUMBING <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />OF EQUIPMENTFEE <br />D. UNITS-H.P. EA• S I <br />NO. TYPE OF FIXTURE OR ITEM <br />FCE <br />RAItA1H <br />TlIBS <br />TNO.TYPETYPE <br />H.P.GIOTNES <br />WASHER <br />I <br />AIR SYSTEMS B.T.U- MEA.DISH <br />VIASHEHS <br />I <br />f. iINKING FOUNTAINS <br />LYALL HEATERS •• P.T.U. <br />—"'"-""Fl <br />OQIt Df1AiN5r <br />KI1'l-:IFN SINKS & DISV, <br />UNIT HEATERS B.T.U. <br />- T <br />BAR SINKS <br />I <br />EVAPORATIVE COOLERS <br />_ <br />HOOF DRAWS RA;N LEADERS <br />DRAINS <br />—�— <br />CLOTHES DRYERS <br />I <br />—T_ <br />SHOWER <br />VNT EILATION FAN <br />SERVI(:E SINKS <br />RANGE HOOD <br />1 <br />SUMPS •. SEWAGE PUNIF <br />. , <br />_ <br />AIR HANDLING UNIT C�F�M_ <br />.. <br />_ . ,.___. ._.... __..�..T.� <br />WATER HEATER <br />T— <br />URINALS <br />_ <br />WATER CLOSETS <br />-- •- <br />i <br />YJAlk 11 Hk ATEIiS - ELECTRIC <br />_ <br />_ <br />,. _.. -. <br />_. .. .. <br />FAC. QUILT FIREPLACE K CHIMNEY <br />" _ <br />GAS. SYSTEM: NO OP OUTLF.IS _ <br />.GUTI TOTAL..._5 <br />1 <br />... <br />T' <br />I <br />—BASINS <br />I <br />LAUNDRY TT1AY5 <br />SUO TOTAL <br />TOTAL FEE 5 I <br />T111$ PERMIT 11ECOAlES NUI 1. nNO V&O 11 Wt tI11: ON CONST RUC <br />71ON AUTIIOnIZED IS NOT CUMA{INCED WITIIIN 1?0 DAYS. OR IF <br />CONSTRUCTION OR %VOHK IS SU:{I'1'NOCD On AIIANDONEII FOfi A <br />PERIOD OF 170 DAYS AT ANY TIN1F AF TEN WOIIK I:; CnME.IENCLU. <br />_ <br />1 <br />PERMIT S <br />N _ <br />—�— <br />TOTAL FEE <br />WATER $ER V ICE 512E BIDG. <br />SUPPLY SIZE <br />I IH AkfiY CERTIFY THAT I HAVE HEAD AND EXAMINin THIS AP <br />PLICATION AND KNOW TILE SAME TO IIE TRUE AND C(lnni cL ALL <br />bluL YAIiU ]r-1 ALn <br />,i7 L S' BACK <br />HLAN YAHOSLTUACK <br />PROVISIONS OF LAWS AND 01I)INANCES GOVERNING TIIf$ TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />USL ZUNk <br />LU7 AIILA <br />' <br />On NOT. TINE GHANNNG OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTIIORNTY TO VIOLATE OH CANCEL THE PROVISIONS Of <br />ANY OTHER STATE On LOCAL LAW IILGULATIN,; CONSTf1UCT10N <br />VACANT SITE <br />❑YES ❑NO <br />On THE PERFORMANCE OF CONSTRUCTION ' <br />a <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />' <br />x_ ?1�- <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />r <br />SIO ATUF(EOPC(1NTRACTOF OIi AVTELAL;ENT DATE <br />_ <br />1 IIIt LONE <br />' <br />II A:aMLNf <br />FILOUHI INK Ll115 <br />HL(lUllllD <br />LAN L'MECK NUM1IHL14 <br />v�� <br />PLAN CIILCK bLL <br />❑Yl5 ONO <br />y fEES <br />FILL IIECEIPT NO <br />VALUATION I FEE <br />SPECIAL CONDITIONS: <br />1 <br />BUILDING <br />$ <br />- 1 <br />SEPA REVIEW COMPLETE DYES CI NO <br />PLUM111NO <br />1 <br />1 <br />cordPlGnnlnq dept. <br />MLCIIANICALBct <br />� <br />1 <br />.. 1.. _.... <br />- <br />OTHER <br />I <br />1 <br />PENALTY <br />SEC. JBJ IN, <br />1 <br />Vf LICAIWNAIIVIIOKY <br />r1 N%CIOLKLUUY <br />AMNUVIO 01N4,1UM1NLI YY <br />TOTAL <br />1 <br />