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- CONSTRUCTION 9/'J%77 <br />3z�9 <br />PERMIT APPLICATION <br />COMBINA71ON • BUILDING • MECHANICAL • PLUMBING <br />UWNL It <br />MAIL AOLOO ..'. <br />21P YrIUNL <br />AHCHITEC/ UH OLSiUNtH <br />MAIL AOURESS <br />PHONE LICENSE'NU <br />OENLRAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE - LICENSE NO. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PERMIT <br />CLASS OF WORK <br />❑COMBINATION <br />❑BUILDINO ❑PLUMBING ❑MECHANICAL <br />❑N[W <br />❑ADOIT TUN ❑ALTEIIA TIUN ❑IILIb11 . <br />VALUAtlO'N OF WORK <br />- • -� <br />p /) <br />/ <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑!;WIMMINCI POOL <br />f e.� L <br />DLSCRIOE WORK <br />00 <br />PROPOSED USE <br />OTHER PERMITS OR APPROVALS <br />�R r <br />tIRE ZONE tj SPECIAL USE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOURc PIES( /7•-„�O <br />.VARIANCE tI SFARLINE <br />LOT BLOCK —OF <br />5EPA CHECK LIST IkEQUIRED <br />V L <br />L-t YES <br />Z j NO <br />JOB ADDRESS i <br />MECHANICAL <br />w, •y <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑Gns ❑FLEE. <br />TYPE OF EQUIPMENT _ _ FEE_ <br />�f_•_ <br />NO. <br />...— <br />_ <br />COND. UNITS-N.P. FA. _ I <br />RFT RIDERnnDN VNITS�— <br />._... ._—_.__... _.. <br />ODILLRS ILP LA <br />FORCED AIR SYSTEMS B T.U. MLA. <br />1 <br />- - AT —O.-•�--T— <br />SPACE 6 WALL HEATERS - N.T.U. � r <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />IIAIH IIIRS <br />S <br />CLOIIIFS '(ASHEN <br />I <br />FRI1Nl nI N5 <br />1 <br />FLUUH UIINN$ <br />F1.001ID <br />KIICIII-N SINKS FA UISP. <br />UNIT I/EATERS N.T.U. <br />EVAPORATIVE COOL:H_S __ <br />_T- <br />1 <br />IIAIISINKS <br />IIOOF DRAINS RAIN LCAUE{IS <br />CLOTPIES DRYERS <br />T- <br />SHQWkR RAI HS <br />VENTILATION FAN <br />SERVICE SINKS <br />RANGE HOOD <br />1 <br />SUMPS • SELYA(;E PUMP <br />--------' -�—"'- <br />AIR /1ANOLINp UI:IT C.T.M. <br />URINALS <br />WAl E R CI OSLT$ <br />ATEIIS - ELECTIII <br />•_ <br />_WATER NFATER <br />,_ •_ � <br />1 <br />_WA111111f <br />WASH IIASINS <br />i <br />FAC. BUILT rIREPLACE K CHIM_NLY <br />_ __... <br />GAS. SYSTEM: NO OF OUTLI iS� <br />SUIT IOML_S <br />� r <br />LAUNDRY TRAYS <br />_ <br />_ _I <br />I <br />_---- DOTAL FE_k' I <br />SUB TOTAL <br />_S <br />IIIIn PEIIMIT RECOM FsNIII t ANO VOIR II WUIIK OH r.UNST RUC <br />_PEN MIT _ <br />S <br />110N AUTIIUGIZEO IS NO? CUMMLNCID WITHIN 170 DAY';. OR IF <br />T <br />CONS(IIOCTION OR WOIIK 1!; !iUS"i NOED Oil AIIANDONLD FGN A <br />WATER SLR V ICE• ^u17E BERG. <br />SUPPLY SIZI <br />PEGI00 at: 120 DAYS AT ANY (IMF At Tr F/ WOOK IS COW1.4 NCLD. <br />I11/HLIIY CERTIFY THAI I HAVI, NIAO ANn EXAM min THISAP <br />1 ...1 A S UA' <br />HLANYARUSt TUACK <br />ILICAI ION AND KNOW TILL 2;AML TO LIE TGUE AND COHIO CT. ALL <br />PnGVISIONS OF 1 AWS AND OFIDINANCES GOVERNING 11/IS TYPE <br />OF WOIIK WILL BE COMPLIED WITH WHETPIER SPt CIFILO Hr REIN <br />.-_ •,__ _-,-,- - <br />U!ll ZIINL LUT AIILA <br />,- --,. ...__.--._ <br />VACANT OITL <br />OR NOT. Tilt GRAN7ING Or A PLGMIT DOER N01 PRESUME TO <br />GIVE AUTOOTOTV TO VIOLATt OR CANCLL T11E PROVISIONS OF <br />❑YES ONO <br />ANY OTHER STATE OR LOCAL 1 AW IILGULATINU CONRTTIUCTION <br />TWCUICONST. OCCUPANCY GROUP NO.OI OWELLING <br />OR TILL PLFiFORMANCEOF CONSTRUCTION , <br />i <br />UNITS <br />812L OF SLOG. NO. OF STORILS <br />A%.00 . LOAD <br />x <br />_ <br />91GNAI UTIL Of CONI RACT Oil On AUTII. ARLN1 DATE <br />I (III: lI1NF -- IIA'1l BIZ N1 <br />ILUUI.I'111NIfllll- <br />RLUUIIILII <br />L.IN CIII L'K NUMIIl11 PLAN COL I -KILL <br />❑YTS ❑NO <br />� ILE RECEIPT Nit <br />SPECIAL CONDITIONS" <br />-FEES VALUATION - FEE - <br />IIUILDING <br />1 <br />SEPA REVIEW COMPLETE: ❑YES ❑ NO <br />PIIIMGINII <br />Contact Plannlnq CLOPt. <br />MLCIIANICAL I <br />I <br />Oi11ER I <br />MIIPl KINALUrliullY rlANLCMLLl1u IY <br />WA0Yl0 OBI IT <br />PENALTY SEC. 3071M 1 <br />1 <br />1 <br />_�—�• —. __.. _._- • -. _�-....1..�- <br />:/\ <br />TOTAL 1 <br />