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' 1.UNIJ I. tluu I lull <br />PERMIT APPLICATION ` <br />COMBINATION • BUILDING <br />• MECIIANICAL • PLUMBING <br />JWNEH <br />MAIL AUUIIL" <br />LIP 1•HUo, <br />NIICHITECL UII UGSIONkR <br />MAIL ADUIIESS <br />PHONE LICENSL NO <br />SUATIAL CON TRACTOR <br />MAILADORESS <br />PHONE LICENSE NU. <br />t <br />ALCHANICAL CONTRACTOR <br />ADDRESS <br />PHONE LICENSE NO. <br />' <br />'LUMUING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NU. <br />�(iM1T <br />CLASS OF WORK <br />--------- <br />('ICOMBINATION <br />❑BUILOING []PLUMBING ❑MECHANICAL <br />❑NEW <br />❑ADOIT TUN ❑AL1Ef1A TIfIN ❑11(1'Alll <br />i, LUAf10N OF WORK <br />❑OE TOOL IS <br />�• ��• ����------_--- <br />❑FENCE ❑SIGN ❑!iWIMMINfI POOL <br />S <br />fESCH10E WORK <br />HUPOSEO USE <br />6THER PERMITS OR APPROVAIS <br />REZONE .SPECIAL USE <br />(GAL tlkSCfUPTIUN OF PROPEFITV (SHOW <br />OUnCp PIES' <br />BELOW OR AT TACIT <br />�T <br />VARIANCE Lj SHORLINE <br />./ '0 n <br />_ <br />OT OLOCK_OF1 <br />SEPA CHECK LIST REQUIRED <br />rr YES <br />3ZI• NO - <br />L <br />)0 ADORLSS <br />��L'/y <br />_ <br />f - <br />'MECHANICAL _ <br />LUMIBING <br />TYPE OF ENERG Y <br />❑ff AS IEC. <br />_ —❑tE <br />NO. TYPC OF EOUIPMENT A •-`_„««FEE,__ <br />_ _ <br />Alii_ CONO. JNI15-/L P. CA. --• <br />!U. TYPE OF I IXTURE On ITEM <br />_ <br />FEE <br />-d <br />pEF nlOERf i ION ulil r5 uN Ln, <br />•-••-•---•—�_ <br />IIA111 IIIUS <br />S <br />OOIl Ef15 ILP A. 1 <br />TU1011HESVIASHER <br />_ 4�0 Q1 <br />7011Cf6Ali15YSTFi,1: <br />OISII LYASIIEIIS <br />.G•I f9 Ci <br />—"--•«�' '--' - "--' — —1 <br />5 <br />OR1NY.ING FUIINTAINS <br />I. <br />— ••• -- -• ---' T— <br />SPACE. L WALL_HEnIER_S_• II.T.U. <br />FIOON UIInIra <br />1 <br />1/ KITCHEN S114KS A ON <br />UNIT HEATERS B,T.U. <br />EVAPORATIVE COOLL ITS- <br />UAII SINES_ I <br />11001nHAlt•S WAIN 'CADET'S <br />CLOTIIfS DAYE nS!/(�- <br />511011'ER IL11 NS <br />VENTILA tIDN fAN�C.)� <br />_. -- <br />!iC ItVICF. $INP.S <br />RANGC HOOD (qOU <br />_SUMPS - SEWAGE PUMP <br />AIR.HANDUNG UNIT• • <br />cx.m. 1 <br />UIIINnLS <br />I <br />_ •. ,•• �• <br />1 <br />t- WA1C11 CLOSE.IS <br />O <br />--• • -• •• - •- •ter <br />WnILR HEATERS - ELLC1111C <br />_ •WA'fFp.NEATER _ <br />WASH BASINS <br />RAC.FIREPLACE A CIIHA_NCV•.., 1 _ <br />LAUNOnY TIIA S • <br />_GUILT •-. <br />GAS SYSTEM: NO OP OUTLI 1$--.-+. _ <br />••' '� TO <br />SUIT T(11A1 S <br />�- • Y•- <br />OE it <br />_ <br />TOTAL FfE S ' q-- <br />SUO TOTAL <br />UUC <br />THIS AfV"it UCCO•AS NUI L ANn VDIII 11 1YON 0 <br />PERMIT _ <br />S <br />EI WIT' AVV;. OR If <br />NUIIIORILOr IS NOT 1?O tlA <br />TOTAL FEE <br />!, 3UTALNCI <br />All D <br />DONST IIIICIIOI! On WONK I!: SU!U•1'NMD OR A(IAN OO NLD fOp A <br />CON <br />1TEn SERVICE SI7E I IILOG. <br />SUPPLY SIZE [_-� <br />PERIOD OI 120 DAYS AT AN' IIMI AF 1E11wnnK 1^ COM01,NC1LD. <br />I HERtnr Ct"TIFr nlnT I nAVL PILAU ANn E<n MlNln fills AP <br />f(�L i Il�i�1�ALn Il ..•Lnc6 <br />ntnN rn11u 5t tuner., <br />PLICATION AND KNOW THE SALIt T(1OIL TnUE AND C011I1I CT. ALL <br />I, <br />PROVISIONS OF LAWS ANT) OIInINANCTS (.OVEIINING ?HIS TYPE <br />OF WORK Will. DO. COMPLIEO WITH INHETHEn SPCCIF1Lf1 uEntm <br />_ <br />tL LO 1. LUl ANLA <br />VACANT' '.ITk <br />0O NOT, nU. GRAN;INR OF n PERMIT nDC.^, NO1 POf SVAIC TO <br />• <br />OYES ONO <br />ti1VE AU71,0IIITY TO VIOLATk Oil CANCEL TIIE PH(IVIMONS Of <br />11LOULAIINIl CONSTIIUCTION <br />+PL OOF CONST. OCCUPANCY'U/1UUP NU. OF UWk i.INU <br />ANY UIIIFR ;TAIL on IOCAL LAW <br />Oil THE PLIIFORMANCE Of CONSTIIUCTION. <br />UNITS <br />LE OF OLOO. I Z NO. OF STORIES <br />MAX. OCC. LOAD <br />q F) 7�_ <br />X <br />SIONATUIICCUNT OF RACTDIIOR AVTI/. AGENT DATE <br />IIk RI)fJk IIALTM I <br />/lllt!.;rr11N I. �IIS �srw.�� �•� <br />HLOUIHt 11 <br />I-]YIS ONO <br />l• 1•pNIHLLK NUM"LH 1'L AN CHECK ILL <br />TLC RECEIPT Nn. <br />k CIAL CONDITIONS: _ <br />� <br />'941w <br />«• _ <br />ifl LUATION _ FEE <br />iEPA REVIEW COMPLETE : DYES <br />• <br />❑ NO <br />PLIIAIIII NII <br />�<<� <br />I <br />contact PlGnnlnq dept. <br />MLCHANICAIy_ NI Q tj <br />.. <br />OTHER 1 <br />_ t <br />.1"114INAlL1Il1Y YI aAM)l»Ill1U A• <br />AnMioO 11.7 WWAKI it <br />PENALTY SEC. 303lil 1 <br />TOTAL <br />T-i;-7,,/ <br />srl <br />..-:-.. <br />