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CONISTRUCTION <br />PERMIT APRICATION <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWN,k[1Q1HUNL <br />MAIL7r%� <br />Y <br />��/1 <br />(i+• �Y ,tc' <br />A'RCHITEC7 Uq OESIUNEH y <br />MAILAODRILS5 <br />PHONE LICk N:E NO <br />6ENCgAL CONi RACTO/i j <br />MAIL ADD14ESS <br />PHONEI LICENSE NO. <br />MECDANICALCONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMUINGCONTRACTOH <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PERMIT <br />CLASS Of WORK <br />❑L�BCOMBINATION <br />IY OUILDING ❑ PLUMBING ❑Mk CHANICAL <br />❑NCW <br />Ix ADDITION ❑ALTIItA(IIIN ❑IIL 1'n111 <br />VALG'X IONUf WORK <br />9500 <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑4WIMMINO POOL. <br />f <br />DESCRIBE WORK <br />,IO%'vem/ <br />PROPO5LD USE <br />OTH ER PERMITS OR APPROVAIS <br />13 REZONE tj SPECIAL USE <br />VARIANCE SHORLINE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW B LOW OR ATTACH <br />FOUR IL" <br />E 1 �/) lj <br />it�� ,�/ 4j� <br />LOT BLOCKT_oF <br />�.or� <br />SEP <br />A CHECK LIST REQUIRED <br />= YES <br />L1 NO <br />JOB Aoo'aess // <br />j Q _ ) N� <br />MECHANICAL <br />PLUMBING <br />Ald <br />TYPE <br />Of ENERGY <br />(]nn5 <br />TYPE OF EOUIPtdCNT FEE_— <br />—•-••� <br />NO. <br />Al/i CONIO. UN1T5-N.P. LOC. IT 1 <br />'Rkl RIGCRnTION UNIr.^. uP. LA- <br />BOILERS II.P IA.—L-- <br />FORCED AIR SYSTEMS R.T.U.UEA. —T- <br />l <br />1 <br />-• —•- --- -- —1'— <br />_5I•nCC b WALL HEATERS - R.T.U. <br />110. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />_ <br />IIAIH hills <br />s <br />— <br />CLOTHES WASHER <br />S <br />01511 WASHF its <br />DRINKING FOUNTAINS <br />1 <br />F1 UOR DRAINS <br />1 <br />_ <br />KITCHEN SINK) & DISI. <br />I <br />UNIT IuE ATE RS H.T.U. <br />EVAPORATIVE COOLERS �_ —_- <br />T� <br />IIA•11 SINKS <br />1 <br />IIOOF 011M (JS IInIN lLAl7L 11S <br />�T <br />CLOIOILS DRYERS-- <br />HH0I4ER IIAIHS <br />_ <br />VENT IL AT ION FAN <br />HER'/ICE SINKS <br />gANGE IIOOU 1 <br />SUMPS - SEWAGE PUMP _ <br />_ <br />'— <br />AIR HANDLING UNIT FT, <br />URINALS <br />- —__—. <br />WAIL II CI OSI'15 <br />... _ ... ___. ...... <br />"--"-- -'�—'- <br />WATER III:A IF ITS CLIICI HIC <br />1 <br />WATkfIIFATEN <br />..._ _. .. __..REP .._ ... ._ _...1.-- <br />I4ASN dASIN'i -- <br />I <br />FA C._BUILT FIREPLACE h C/IIM_N_ EY �.. I _ <br />LAUNL•(IV MAYS <br />_ ., <br />ETAS. SYSTEM: NO OP OVTLI AS <br />ruR to FAIL <br />—•1 <br />1 <br />—.--- YOT.AI (EF L <br />SUB _TOTAL <br />_ <br />�t 1115 PLIIAIIi UkCOMkU Nlll1 nND VOID 11 WI1111( OR CONSTRUC <br />PERMIT <br />5 - <br />TI IN AUr11UFDztn 1^. N01 r.(1MMENCI O (YIi 1nN 1?O DAYS. (1R IF <br />CONSTRUCTION on W'oltK IS swwl NGED OII ArIANOONED roll A <br />IPA7ER SEA VICE S1717 GLDFr SUM <br />Y SI71 <br />PERIOD OF 170 DAYS AT ANY 1101 At ILR WORK n: CO1.V,TL NCLU. <br />mury S <br />1 IIEFIEIIY CtnT1(Y THAT I IIAVL IILAU AND E`IAk•IN(G II11l. AP <br />u NIL u UAL'K <br />FILAR YARD Sk 1BACK <br />PLICATION AND KNOW III[ SAME TO IR. TIIOr ANOCORRICT. ALL <br />Q• / <br />(V/ 7 <br />Q (.J <br />/ <br />PnOVISIDNS or LAWS AND ORDINANCES GOVERNING IMS TYPE <br />OF WOIIK WILL OF COMPI JED WilliWRETHF,n nprc to HEntiN <br />UIIL ZUNL -� lUT All A <br />VACANT CITE <br />on NOT. THE ORAN7I14(1 of A PEFMIT DOES NOT PRESUME TO <br />❑YES ❑NO <br />(FIVE AOI IIOOITY TO VIOL AIt- (114 CANCLL TIIE PROVISIONS Of <br />ANY 0111L R SI AT E on LOCAL I AW IILOULAT IN17 COWMIUCTION <br />TYPE OF CONST. OCCUPANCY GROUP <br />NO VI DWELINU <br />Go T11L PLnFORMANCL O1 CONSTRUCIION <br />f <br />_� j- H T <br />SIZE O LUX., NO. OF Sh OIiICS <br />UNITS F <br />MAX. 000. LOAD <br />A•w )'? <br />(6461656ilerAclo <br />•/U- <br />1•ILRZ/)N� 11%r{EML N1 <br />IIfC"W71NKl(IN <br />SItNMZlonl�'tXU <br />NT GAS! <br />' <br />FILODUIL0 <br />❑YLB BAD <br />LAN CHL CK NVMIILH PLANLIILCI; 11:1 <br />RECEIPT NIT <br />SPECIAL CON017 IONS _� <br />/J / // FILL <br />/1 JO� .: ` <br />•• •. <br />_ FECS VALUATION FFE <br />I <br />"—•—�•—" <br />IIUILOING 5 ; •.?•(� LS 1� <br />$EPA REVIEW COMPLETE: OYES <br />❑ NO <br />J_ <br />PII/MITI NIi 1 <br />—y 1 <br />contact plannlnq dept. <br />MECIIANICAL —i <br />I <br />1 <br />on1ER 1 <br />�ll(MIUM µ(IIIIY BY HAMI C•IILNBYY <br />OPPBYID (IIIILWAI4IFY <br />PENALTY SEC. 303W <br />--- ----- - --- 1 <br />. / <br />TOTAL ;_• 1 LI T/ <br />I <br />