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-CONSTRUCTION . <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />6ENCRAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE <br />LICENSE NU. <br />1 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE <br />LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />CLASS OF WORK <br />❑COMBINATION <br />❑OUILDING ❑PLUMSIN13 ❑MECHANICAL <br />Cl NEW ❑ADDITION ❑ALTE ILA TIEIN 7NL1•nlll <br />VALUATION OF WORK <br />❑DEMOLISH ❑FENCE ❑SIGN ❑'IWIMMINIL FOOL <br />L <br />OE:CRISE WORK - <br />PROPOSED USE <br />OTHER ER PERMITS OR APPROVALS <br />j� REZONE $( SPECIAL USE <br />#$VARIANCE t( SHORLINE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR CO�ESI <br />`-maW,-&=a <br />LOT SLOCK—OF <br />5EPA CHECK LIST REQUIRED <br />= YES <br />3:3 NO <br />L <br />JOB ADORE '✓ n <br />MECHANICAL <br />PLUMBING <br />TYPE OF ENERGY ❑I{A.:. ❑fIE C. <br />Na TYPE OF EOUIPMENT _ _ _FEE__ <br />- <br />_ <br />AIR CONO. VNITS-H.P. EA. IS I <br />REFRIGERATION UNIfS_HP. EA. I - �— <br />OOiLEAS14P Ea.- <br />iORCED AIR SY Si ETAS P.T.V.. MEA. �— <br />— '---•" -- I <br />" - -- -+T--- <br />SPACE d WALL HEATERS -• B.T.U. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />• <br />RAIH TABS <br />S <br />• - <br />CLO THES YIA SHEH <br />r <br />DISH WASHERS <br />1 <br />011INKING FOUNTAINS <br />., -1,1,1 ,,,,. ,,,,. <br />I• <br />CLOTHES DRYERS l I <br />--- r T - <br />RANGENOOD <br />AIR HANDLING UNIT _ - C.r.m. - <br />91C 1 _— WATER HEATER.... — _•.-- <br />FAC. BUILT FIREPLACE_A CHIMNEY - <br />- OAS. SYSTEM OF DUTLf. 15 <br />1 <br />-- TOTAL FEE_5�/7 <br />TI/15 PERMIT IIECOMES NIIt 1. ANO VOID II WIIIIK Il" CIINSTRVC <br />TION AUTIN)RILED 15 NOT COMMLNC(O WITHIN 120 DAYS. OR IF <br />CDNST RIrCT ION On WONK 1!i SU!R•1'NDED OR AIIANDONEO FORA <br />PERIOD OF TWO DAYS AT ANY TIME AFTEII WORK I :COMMENCLD <br />SUB TOTAL <br />PERMIT S <br />_ <br />TOTAL FE <br />, <br />NATER SERVICE SIZE BLDG. SUPPLY SIZE <br />I I IIERI IY CERTIFY THAT I iiAVE REAO AND EKAMINIO TRIS A- <br />^LICATION AND KNOW T/IE SA061E TO HE TRUE AND CDIIRI'C T. ALL <br />c <br />LLA K <br />NkAH YAND Yk iiIAG <br />PROVISIONS OF LAWS AND ORDINANCES GOVEONING 71415 TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER !:PE CIF ILD HEREIN <br />UBL TU N C — <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AU1r10RITY TO VIOLATE OR CANCEL TILE PRUv151ONS OF <br />LOT ANL-J <br />VACANT SITk <br />• <br />❑VES ONO <br />ANY OTIII.n STATE OR LOCAL LAW 11 LGULAT ING CONS T 11UCTION <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF OWE LLING <br />OR THE PLRFORMANCE OF CONSTRUC710Nt <br />UNITS <br />SIZE OF OLOG.:Ai iA- <br />NO. OF STORIES <br />MAX. OCC. LOG.] <br />1 <br />21 �(p� <br />SONR—A UREOPCONi RACTOII ONAUTII.AC.LNT DATE <br />I INI <br />U/1-k ML NI <br />IIRL lY1/( INK1.[I� <br />RkOU1RL(I <br />❑YES ONO <br />PLAN C/Ik CK NVMIILH <br />PLAN CHLCK fLL <br />FEES <br />ILC RECEIPT NO. <br />VALUATION FEE <br />SPLCIAC CONDITIONS: <br />1 <br />�--�-- <br />BUILDING <br />S (f <br />SEPA REVIEW COMPLETE: ❑YES <br />❑ NO <br />PLLFMnwG <br />`� ICE L <br />` <br />Contact PIOGOIOO dOpl. <br />._— <br />MLCIIANICAL <br />- <br />1 <br />OTHER <br />I <br />1 <br />EEC. OO]Id <br />1 <br />VPLIGIIXWKLIFILUFY A .OYIG o.6 .hUFT <br />PENALTY <br />11"us"ILAL1011v: <br />F <br />TOTAL <br />_..-----"_.. <br />-��•`//ia'LIG <br />i <br />