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UL)IVS 1 KUL- 1 IU14 <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL PLUMBING <br />JWNE 11 MAIL AUUIIL;,S LIr PHUNL <br />ARCNIT CCf 1/11lyc-51 N-0I MAILADMOESS PHONE LICLNSE NU. <br />3ENE6AICON TT RACTOR MAIL ADDRESS PHONE LICE N51i NU. <br />AECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />TU—PAdING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />'E RMIT CLASS OF WORK <br />❑COMBINATION <br />OBUILOING ❑PLUMDING ❑MECIIANICAL <br />❑tl[W ❑ADDITION ❑ALTE ILA TI(IN ❑If LI•Alll <br />)ALUAT(iN OF WORK —• •+- ••-r•- __— <br />❑DEMOLISH ❑PENCE ❑SIGN ❑!AVIMMING POOL <br />)ESCRIDE WORK ' <br />ROPOSED USE OTT�IHER PERMITS OR APPROVALS <br />tjI AL OAsCnm7 ION OF PROPERTY (SHOW BELOW OR ATTACH '+�' REZONE SPECIAL USE <br />OURCCOPILSI qo� .VARIANCE .j SFORL114E <br />OT. W -BLOCK—OF F--Zt�L. ' <br />SE PA CHECK LIST REQUIRED <br />it YES <br />LZj NO <br />')0 ADDRESS <br />(MECHANICAL <br />LUMBING TYPE OF ENERGY ❑fTAS _ ❑ELEC. _ <br />NO. TYPE_ OFEGUITIMCNT FEE _.._ <br />AIR COND. UNINITS-_II.P, FA. f I <br />10. TYPE OF FIXTURE OR ITEM FEE i1LFR10ERAil6NU_NIfS_11V Cn.-__� L <br />RAM IIIUS f •D011EnS H.P fA. 1 <br />CIOTHlS YJn SHEH _IQeDRCET) Alit Sr STEi.i7 U.T.U.. MEW. •� <br />DISHVJASHEIIS KiQ I <br />O FIINt:IN(3 FOUNTAINS I - —• --�•' '- -' T`-- <br />FIOOII DIlA1N$ 1 SPACE L WALL HEATERS •• R.T.U. •_�I <br />KIT00N SINKS A DISFJ. frU UNIT_11EATEnS H.T.U. <br />L <br />IIAII SINKS l EVAPORATIVE COOLCI_IS <br />IIOOI nIl A1R5 RAIN LLM)E ltf CLOTHES OnV(nS 10 <br />. 'HOVAH IIATHS V EIJT LLLATION TAN TO <br />SERVICE SINKS � MNGC ROOD b <br />SUtJPS - 5F.1VA(iE VUMP AIR IIANDLING UNIT----C.F_M; •.-r I <br />URINALS <br />OVA IE 11 CO. OSC)S <br />ATE 1�14f 11LE11S - ELECIRIC 1 •,- WATT <br />W. .HEATER , <br />F. <br />BUILT FIn EPLACt A. C1HL1_NEV_ __ 1 <br />LAUNDRY Tf1AYs OAS_ Sy St ­EM7 NO OP OUTL115 _ -_ •-T-- <br />J L- <br />--- - '.U0 i0 TAP. 1\o•t1 U_ _ <br />-•-_•_ PERMIT _5 .._..�. 1. 0 <br />------TOTAL FEE -S �100 <br />MU <br />Sun TOTAL jjjjS 14 fl LILT OECnES NI L AND V[HU II 1Vflltr 11H CONSTRUC <br />PEff'O _ S U TION AUIIIORIIED IS NOt CONMLNCIn W1T1114 170 DAY., OR IF <br />1 E CONSTI1t ICTION OR WORK I!; SUIIYI'NIIEn Olt AIIANDONEn FOR A <br />1TER SERVICE S17E BLDG SUPPLY SIZE PCnIOD Of 170 DAYS AT ANY 11Mt At TCFI WOFIK 1!.COt.9JENCLD <br />fJ. 1: UACn 'T II C SL7 UAC �r HtAN YAHU SF ItlACb I FOPPERY CERTIFY PRAT I RAVE HLAU AND EXAMINin fnlS AP <br />PLICA/l(IH AND KNOW lift ,AME TO OIL 7FILM AND C011111 CT. ALL <br />PnOV11.10N5 OF 14WS ANU OIInINGNCES DOVE"NING IMS TYPE <br />OF WOIU; WILL BE COMPL IEO WI fit VINE T,lE 11 •:PC Cif it 1) TIC FIE 1-4IC 20NL _ LUl ARIA VACANt SITE Off NOT. IIIE GRANTING Of A PERMIT OOl!i NOT PftESUME TO <br />(LIVE AIIf HOO1TV TO VIOLATE OR CANCLI. fnE Pn(IV1510N5 Of <br />• OYES ONO ANY OIHEn STATE On LOCAL LAW HLOULAT INu CONSTIIUCTION <br />APE OOf CONST. OCCUPANCY GIABLIF NO.OF DWELLING On THE PCBFORMANCE OF CONSTRUCTIONF <br />UNITS <br />ZE OF OLOG.ZA Y I& NO. OF STORIES MAX. OCC. LOAD <br />3 r UJr o 2 x <br />Ilk-'LONF— MXS. MLNI 1-iriI .1•II INK I. CIIFi SIfiNATUIIC OF CONTRACTOR( OIIAUTII. A(ikNF DAtF <br />RLRUIIILU -) <br />LAN 111E CK NVMULI/ 1'L AN COILCI, F LL <br />❑YES ONO PLC p �y� RECEIPT NO. <br />LCCAL' CONDITIONS: <br />FEES VALUATION FF.E <br />UUILOINa IF-7 <br />PLULIIIINII /r ��Q <br />iEPA REVIEW COMPLETE ; ❑YES ❑ NO _. _ I <br />confect plannlnq dept. MECHANICAL —�CI IQU <br />P._.... <br />o T11En <br />KwIgN FLlIR1u rT rurF rwwyun M+wvI• o111 AmI+• PIFNALTY SEC. JO�IF) T <br />TOTAL <br />