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- CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING IF MECHANICAL P PLUMBING <br />OWNLH MAIL AUUML" <br />ZI► PMUNL <br />AAA H ITECT UH—bOF G N k A MAILADORESS <br />PHONE LICENSE NU <br />GENERAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />MECHANICAL CON T RACTO H MAIL ADDRESS <br />PHONE LICENSE NO, <br />PLUMNING CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />PERMIT <br />CLASS OF WORK <br />❑COMBINATION <br />❑BUILDING ❑PLUMBING OMECHANICAL <br />1PAIR <br />❑NEW <br />❑ADDITION ❑ALTEMAFIUN ORE <br />VALUATION OF WORK <br />❑OEMOLISH <br />❑FENCE ❑SIGN ❑SWIMMIN(i IDOL <br />I S <br />(DESCRIBE WORK <br />PROPOSED USE <br />OTHER PERMITS OR•APPROVALS <br />jI RE ZONE tj SPECIAL USE <br />t.VARIANCE 13 SHORUNE <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />FGURCOPIESI I <br />LOT �— BLOCK—OF�� <br />�I <br />5EPA CHECK LIST REGUIRED <br />i <br />i3' YES <br />L3 NO . <br />JOB ADDRESS (,I <br />PL_., <br />�j•1= <br />i� L (1)Le, -T I. <br />MECHANICAL <br />PLUMBING <br />TYPE OF ENERGY <br />❑tins ❑ELF. <br />C. <br />FEE <br />NO. <br />TYPEOFEOUIPMCNT_•, <br />--- <br />_ <br />AIR COND. UNITS-H.P. EA. <br />REF RIDE RATION UNITS NP. LA. <br />OpHERS //.P EA.------ <br />fORCEO AIR Sr STEMO B.T.U. MEA. <br />S_ 1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />j-- <br />I <br />NA1M TAUS <br />S <br />CIOTHES WASHER <br />I <br />DISH YMSI/F HS <br />I <br />SPACE & WALL HEATERS •• B.T.U. <br />—T <br />I <br />DRINKING FOUNTAINS <br />I <br />_ <br />FIUGH OFIAUIS <br />I <br />KITCHI-N SINKS & UIS . <br />1 <br />UNIT NE nTE RS B.T.U._ <br />_I� <br />IIAII SINKS <br />EVAPORATIVE COOLERS'—___ <br />HOOF DRAINS RAIN LEADERS <br />1L <br />CLOTHES ORrkR1 <br />SHnWLR OATHS <br />If <br />VENTILATION FAN <br />SE"VICE SINKS <br />RANG, HOOD 1 <br />SUMVS -SEWAG PUMP <br />_ <br />AIRHANOLINC UNIT _-- CJIM, I <br />UMINALS <br />'- '---_— <br />1 <br />WAI III CLOSC <br />`WA - - _ - _.._... <br />WATER HEATER <br />WATEII HLATEIIS - ELECTRIC <br />WASH BASINS <br />I <br />I <br />•,- <br />FAC._BUILT FIREPLACE & CHIMNEY <br />RY TRAYS <br />LAUNDRY <br />_ <br />OAS SYSTEM: NO OF OU_TLF IS <br />_ <br />Bl/•11 TOTAL S (5 <br />_.�Q <br />—PERMIT S <br />- _�- TOTALFEE S I <br />SUB TOTAL <br />_� <br />HIS PERMIT BECOMES NUI L.ANO VOIII 11 WDIIK ITN CONSTRUC <br />PERMIT S <br />IT <br />ION AUTHORIZED IS NOT CUMMLNCID WITHIN 1?0 VAr7. OR IF <br />TOTAL FEE <br />CUNST"IICTION OR WORK I!{ SUSPENDED OR AIIANOONEO FOR A <br />HATER SERVICE SIZE BLnG. SUPPLY SIZE <br />PERIOD OF 120 DAYS AT ANY FIMF AFTER WOFIK I!: CUMMENCLD. <br />I IILREIIY CERTIFY TIIAI I IIAVL MEAD AND EKAMINI O tTIIS AP <br />U ul N u BACK HtAH <br />VAIIOSETBACw <br />PLICATION AND KNOW TIII SAME TO III, TRUE AND CE lull CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES UDVERNING TIUS TYPE <br />OF WORK WILL BE COMPLIED WItH WHETFIE" SPECIFIED HE"E14 <br />U9l ZUNt �� LD'1 ARIA VACAN TT Silk <br />OR NOT. TILE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRUVISIONS OF <br />• <br />OYES ONO <br />ANY OTHER STATE OR LOCAL LAW HLE:ULATINC CONSTRUCTION <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF OWE LUNG <br />OR THE PERFORMANCE OF CONSTRUCTION <br />UNITS <br />SIZE OF BLOG.'/ Y.( NO. OF STORIES MAK.00C. LOAD <br />. ..A <br />iL <br />SIGNATURE OF CONTRACTOROH AUTIL A(;ENT DATE <br />IIIik 2ONk - IIAtIMZ EJI <br />IN!'IV /�NKLI�NS <br />' RLOUIHLI) <br />❑YES ONO <br />LAN FHLCK NUMULH PLAN CHECK FEE <br />IkC RECEIPT NO <br />SPECIAL CONDITIONS: <br />1 <br />- <br />_ iFEES VALUATION _-FEE <br />BUILDING S 4-(I?J N). <br />--_ <br />SE PA REVIEW COMPLETE: ❑YES <br />' <br />❑ NO <br />►111MBIN11 / ' <br />Contact PIOnn1Oq dept. <br />1 <br />MECHANICAL <br />_ <br />1 <br />OTHER I <br />�NHE•Hw.uNuu•r +uw,el u.u.- •nwa0 <br />u•wu•wu. Er <br />PENALTY SEC. 7071.1 <br />- <br />TOTAL 1 <br />