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- CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING IN MECHANICAL • PLUMBING <br />MAIL AUUNLSS- ZIP - -PHUNL <br />ECt UH pELI(iNLN <br />;ARCNIT MAI ODRESS PHONE LICENSt NU <br />,O- <br />GENCRAL CONTRACTOR MAIL ADDRESS IRO E LICENSE NV. <br />M_ECHANNIIICC�AL CONTRACTOR <br />MAIL A-0601 E ASS PHONE IICE NSE NO. <br />►ILi TRAIcLTOH� F79AILADORESS PHONE LICENSE tJU. <br />�IHCC�O <br />VE�N !T <br />CLASS OF WORK • - <br />?cc MBINATION <br />❑BUILDING ❑PLUMBING []MECHANICAL <br />2<rW ❑ADDITION ❑AL7EIIA 7ION ❑HU•A111 <br />VALUATION OP WORK <br />�' ' --•• •--- <br />S OLrD �• <br />❑DEMOLISH ❑FENCE ❑SIGN 0'iWIMMIN0 POOL <br />DESCRIBE WORK , <br />PROPOSED USE <br />OTHER PERMITS OR APPROVAIS <br />13 REZONE SPECIAL USE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOU nE51 <br />1� <br />#VARIANCE SHORLINE <br />J--I <br />LOT BR LOCK—GF <br />5EPA CHECK LIST REQUIRED <br />it YES <br />3:1 NO <br />JOB ADO R ESS �T.. -- <br />.303 /L r c cf S. [ <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY ❑IIA, ❑ELF. C. <br />_ _ TYPE OF EOUIPM ENT FEE <br />NO. <br />AIR COND. UNITS-H.P, EA_. <br />-A-Cr R it.ERAtInNvpI TS�i{ En__iL �-T- <br />- <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />_ <br />- <br />TI105 <br />RPlH <br />— -- <br />BOILERS N.I Ea.- <br />A.T.U. MEA. <br />FORCED AIR SYSTEMS �— <br />1 <br />SPACE At WALL HEATERS • B.T.U. —ram <br />ClO1NES WASHER <br />I <br />DISH WASHERS <br />❑AINKINGFOUNTAINS <br />/ <br />FI OOH OHAINS <br />1 <br />KITUIItN SINKS & UISP. <br />I <br />UNIT HEATERS R.T.U. <br />I <br />IIAII SINKS <br />E VnPOT1ATIVE COOLE_AS <br />AOPF DRAINS RAIN LEAOEFIS <br />CLOTHES DRYERS <br />SHnWkFI BATHS <br />VENTILATION FAN <br />liE gVl(:E SINP.S <br />RANGE HOOD _ <br />I <br />W <br />SUMPS -• SEWAGE PUMP <br />• <br />UnINALS <br />_ AIR HANDLING - UNIT <br />WATER CIOSEJS <br />WAlkll HEATERS - -LECTRIC <br />u <br />-� 'wnTFR NEATER _^� <br />1 <br />WASH BASINS <br />/ <br />_ FAG BUILT FIREPLACE A CHIMNEY 1 <br />OAS SYSTEM: NO OP OUTLf 15-"T-- <br />L —_ <br />5U0 x1rnL s 1-i_IOv <br />PERMIT _S .._..._ i <br />_ _-�TDTA_L FEE S 171 100 <br />THIr PEAP.11T OECOMES N(11 L AND VOID 11 WO"K OR CONSTRUC <br />710N AU TnORI ZED 15 NOT COMMLNCED WITFON 1?0 OAYB, on IF <br />CONSTRUCTION On WO11K I!1 SU51-1 NOEIF On ABANDONED ion A <br />PEnloo OF 170 DAYS AT ANY IIMf AF TEA WnAK 111 CnMIJENCED. <br />I IIERERY CERTIFY THAT I IIAVL ALAO ANn ErAMINIn TIIIB AP <br />LAUNDRY TRAYS <br />SUO TOTAI <br />PERMIT S <br />TOTAL FEE <br />-. �� <br />4ATEn SERVICE SIZE SLOG. SUPPLY SIZE <br />1 +L I <br />1 - BACK <br />HLAN YANU Sl7tlAG� <br />tr t= <br />(- <br />"L pt�. 'L7 <br />PLICATION AND KNOW TlIE SAME TO III TAUC AND COARI-CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES COVIONING itRq TYPE <br />USL 2UNL " - <br />'a AREA <br />�.,� <br />OF <br />OR NOT. T11F unAN : WILL HE 711NGLo A EAMITIED WITH E GOES NOT I'AFSUME TO <br />VACANTT SIT! <br />Yvrt OF CONST. <br />OCCUPANCY GROUP <br />DYES ❑NO <br />No OF DWELLING <br />IqIONS OF <br />ANY OTIIEn S IVE ATETOR LOCAL ELAW HEOCA CkL TTINU CON`tIE �7RUCTION <br />On THE PILAF MANCE Or GUNS RVC7 <br />UNITS I <br />SIZE OF BLOC. <br />NO. OF STORIES <br />MAA.00 LOAD <br />Q <br />I <br />x 2/n7�r <br />IIIIi IoNL—��� <br />IIA{7!A�Af <br />EIONATUREO CONTRACT HORA TICALiE GATE <br />IIN!!:ITNkll1T�, <br />Ji <br />IJ C.) <br />REOVIHLD <br />BYES ONO <br />'LANCHLLK NUMdLif <br />r <br />~—FEES <br />1•L AN /ILCK FLL <br />ILL' RECEIPT No <br />VALUATION FEE + <br />II'L<In <br />__- E CONDITIONS- <br />_ <br />OUILDING <br />�.._ I <br />..f <br />PLuMOINII <br />SEPA REVIEW COMPLETE: OYES ❑ NO <br />COniOcl Plannlnq dept. <br />MLCIIANICAL <br />- <br />OTIIER <br />' <br />1 <br />I <br />MIN:AIgN AKIFiIn Yf rLANF L1111,alY YY <br />AMapHO Y 1-NY <br />PFNALTY <br />SEC. 703 IN) <br />1 <br />TOTAL <br />j <br />