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CONSTRUCTION . <br />PERMIT APPLICATION <br />COMBINATION • BUILDING IT MECHANICAL • PLUMBING <br />UWNL1/ MAIL AUUIILSS <br />[IY PHUNt -- <br />f <br />�UOIIEY_ SS <br />111iC/111'LCI UII ULSIUNLII MAIL A <br />PHUNL LIGLNSL NU --- --- <br />• <br />GLNL'nALCO Nf HACTOR MAIL AULMLSS <br />P/IONL LICENSE NU. <br />iJ.iC11ANICAL CONTIIACTUR MAIL ADOFICSS <br />PHONE LICENSE NO. <br />P LVMUING CONTRACTOR MAIL AOURLSS <br />PHONE LICENSE NO. <br />-_-- <br />VLIIMIT <br />CLASS OF WORK <br />❑COMBINATION <br />[j'OUILDING CI PLUMBING ❑MECHANICAL <br />rn/r'��IW <br />1L77 <br />ADDITION ❑ALTERATION 011tPnln <br />VALUAtIUN OF IYV HK <br />•r <br />❑DEMOLISH <br />♦ �_. ..._•_. _.•.___ <br />❑FENCE ❑SIGN ❑•iWIMMING POOL <br />S <br />DLSC/iIUL WORK <br />PHOPOSLU U:L <br />OTHER PERMITS OR APPROVALS <br />REZONE $j SPECIAL USE <br />IPI TUN Of PnOPE FIT V 15110Yf t1ELOW OR AT TACIT <br />FI.V n CVPICSI <br />MNARIANCE SNORLINE <br />tot o[ocK_oF <br />SEPA CHECK LIST REQUIRCD <br />YES <br />ENO <br />' <br />!OB ADOLES <br />-42.(7 IZD 5� S <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY ❑tLLC. <br />TYPE OF EOUIPh1CNT~ <br />""�-"- <br />' <br />• <br />NO. <br />FEE__ <br />'•�__' <br />AIn C01i O. UUNItS-ILP En: <br />nkF nlUkRAnnN UN1 !!: LIP LA. <br />BOIl Ef15 ILP.EA. <br />FUncir AIR Sr 51 cmt;_ILT.V. MCA. <br />•�'• -'' -- <br />SPACE & WALL HEATERS • �1.T.U. <br />f <br />IJU. <br />iViE OF FI%TURF OR ITEM <br />FEE <br />ILA 11/ IIIU5 <br />S - <br />CLOTHES VIA tiN F.II <br />1•� <br />_ <br />Unili WASHEiI$ <br />— <br />—_ <br />-D IONKIN(i FOUNTAINS <br />1 <br />FI OOH IIHA VIS <br />UNIT IIFATEnS R.T.U. <br />? <br />KlICIONSINKSR UISP. <br />- <br />CV TIO.S IVk_CUOLE HS �_��•�- <br />-- <br />I{AH SINKS <br />I <br />IIUOF OIov NS IIA1N LEAO[HS <br />I <br />GLDTIILE OnvE RE <br />SNq'Ak 11 ❑nT HS <br />VENTILATION P;6; <br />SERVICE SINKS <br />RANGE HOOD _ 1 <br />Ir— <br />+C,F-M <br />Sl1MYS tI: AIiE PUMP <br />A11111ANDLING UNIT• ----- _•�-- r <br />U111NAL5 <br />... _. <br />1 <br />'• IYATE II CLOSC.TS 1- <br />... <br />... ..____. ..._.. _-.. .. _.. .. _ ._.. <br />WnTFn 11E ATEN ._ _ _. •_l•_-- <br />�.._.. <br />IVA1Lt1IIEAIEII!i_• ELECTIIIC <br />•••- - -' LT T-O"-" ' <br />fAC, nVllT rIR EPLACC A C/I ININEY-•T_-_ <br />PLASH BASINS -� <br />711AV5 <br />- <br />GAS . SYSTEM: NO OP GUTLI. IS•�-. _ _,_ 1✓�_ <br />'--- ••S. <br />LLUNUiIY <br />— <br />- <br />IOTAL S /Q 1— <br />SUB TOTAL - <br />T11I VF HId1T TIECO'.ILS Nlll LNTI AV0111 ll WIIi1✓ nl: H UNSTIT, C <br />PE II L'.I TS <br />TIIIN AU 11IUn I Z CO 1S NOt f'(it11.4 L NC III WIT I I I N 170 0,% !;.On it <br />fill nnnlJool;ro FOR .+ <br />TOTALC `� <br />CIINSTIItICrION Oil WOnK I;: SLI;IPI-NDCO <br />PI nIOD Or 120 OAv5 of ANY t11A I. n/ TCH Ya1ILK L'tCn.,ndE IJCtU <br />'A1F.R SERVICE S17C_�. __—RLnn. SUPPLY WE— <br />I III F1Ltiv CERT IFv T"AT I NAVL HLAD ANn E•f A1,4NtO t1115 nP <br />71fic LIUACK HEAHYAnUSk1UAGK <br />'f�� <br />PLICATION AND KNOW iIHSAME TORL TRUCANOCUI:Rf CT. ALL <br />PIIOVIMONS OF LANS AND [)ItnINANCFS OUVCIINING 11u5 TYPE <br />•..� <br />SOF •^'�Y_._..'OF <br />WOIIK WILL -HE f.OMPLIEU W 1114 WHLT11E11 ;:PECIFILO HCnCIV <br />NOT PFrt CLIME TO <br />I;;l 7UNL --P•�� LUl AHLA VACANT LiTI, <br />On NU1, tilt /IHAN:11J0 OF APE PERMIT nnt5 <br />OIVC A[1111011ITY TO VIOLATE Oil CnIJCLI fllC I'Itf1VIF10 N5 0f <br />71 ❑YES ❑NO <br />ANY 011lCn STATE On LOCAL LAW 11L6ULAtIN1; CONhTItUCT1ON <br />k•PE OF CO NYI. OC 'UPAHC� [i 11UUl' <br />011 THE PLIIFOHMANCE OF CONSIOUC110N <br />/ <br />UNIT.,UW'�IL/7/LLINU <br />I-Z-�� LOG. NO. OF SIORIES MAX.00C. LOAD <br />;• /J- - <br />I <br />x <br />'SIUNATIIITL Of CONT11ACTn OH AVTII. A(;LNT DATE <br />_ <br />II/L Zul4k IIAMMLNi 111111.IIi1NA 1111 •.'. _I„ ��_ wN <br />• IIL11U11H U rl.:ll tnl Cn NVMllll/ YLANCIILCR I L•L <br />1�y <br />'1J — ❑YTS [3NO <br />CONDITIONS: <br />_ LC PIICCEIPf ND. <br />. <br />...CCLAL <br />FEES VALUATION !-FEE <br />_ 1 <br />IlUILDING <br />SEPA REVIEW COMPLCTE; ❑YES [1 NO <br />IrL11LInINJ-- <br />.... .I. <br />Conlact plonnlnq dept. <br />MLcnANlcnL <br />OTOC11 1 <br />•1KalU✓uuvuVrr rtwKR.K(.Iw rr /A-0wi1. uPruiAlal it <br />PtNALtY SEC 0071AI 1 <br />^... .....-_-.... ..i _.._ <br />TOTAL-_._.....-...�.., ...... <br />A <br />r <br />