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- GO! .�STRUC T IONI <br />PERMIT APPLICAT101,,l <br />COMBINATION • BUILDING P MECHANICAL • PLUMBING <br />OWNER <br />MAIL AUUNkSS <br />it <br />PHONE <br />A fiCNITC[T OP UykS'16NER <br />MAIL AODHE55 <br />4:117 <br />PHONE <br />LICENSk NU <br />GkNIRAL CG,/ACTOR <br />MAIL A DRESS <br />PHONE <br />LICENSE NU. <br />dell <br />WE RA%NIIVAAL CONTRACTOR <br />�MAA,IL ADORES$ <br />PHONE <br />LICENSENo <br />IIVMUIN6 CONTIgAC 0H <br />MAIL,AOORESS <br />PHONE <br />LICENSE NO. <br />PM <br />�=%C. 71NAT <br />M0NQSUIOPLUMBINO <br />CL SOFWORKO <br />MECHANICAL <br />i , <br />EW ❑ADDITION ❑ALTEIIATI()N ORLI•AII+ <br />VALUATION CF WORK <br />�. ...� _•• <br />OOEMOLISN ❑fr'ENCE <br />❑SIGN <br />04WIMMINO POOL <br />DESCRRIDE WITRK <br />- __. <br />4r-e'- 2 -4---1 --vr . <br />I <br />I <br />JOB ADDRESS <br />304 9rs7- P/i S i <br />pNAtEEn SERVICE SIIf. BLna. SUPPLY SIZE <br />915E% 1 L L 1 - UACK Rk A14 YARUSETU, <br />!�CI�'; <br />Uat [UNL LUS ANLA VACANT $ITk <br />�__ __ MET; ONO <br />SPECIAL CONDITIONS: <br />)THER PERMITS OR•APPROVAIS <br />13 REZONE $ j SPECIAL USE <br />tIVARIANCE SHORLINE <br />5EPA CHECK LIST REQUIRED <br />= YES <br />3:3 NO <br />MECHANICAL <br />TYPE OF ENERGY <br />O r;nS <br />NO. TYPE OF EOUIPMENT _ <br />AIR CONO. UNITS-H.P. EA. <br />Rki RiOk RATION UNIfs 11P LA. <br />• - 001LERS I/,P. EA. -_ <br />FORCED AIR SY S7E Mj q. T.U. MI <br />SPACE & WALL HEATERS •• B.T.U. <br />FLEC. <br />AIR HANDLING UNIT - C.f.M_ •�_ <br />WATER HFATE R •--•- - <br />FAC. BUILT FIREPLACE A C/IIMNEY 1..- <br />GAS'SV$TEM: NO OP OUTIf <br />C.UO 7n TAl S <br />TfITAI FEE 3 /A+ I I <br />TliN PF 11M17t OECOME$ NUI I. AND VOID U W511K ON CONSTRUC <br />TION AUf11ORIZED IS NOT COMML NCI O WITHIN 1?0 DAY,^+, OR if <br />CONSTnLICf10N OR WOnK I;) SEI401 NDED Oil Af1ANOONEO FOR A <br />PEnIOO OF 120 DAYS AT .%NY IIMI AE TLII WOOK IN COMLIENCJD <br />1 11ERE11Y CERTIFY, TNAI I IIAVL DLAO ANn EKAMINIIT fills AP <br />PLICATIDN AND KNOW T/IE SAME TO 11E 71111E AND CEIIIRI CT. ALL <br />►nnVISIONS OF LAWS AND OIIDINANCES GDVEnNING Tins TYPE <br />OF WOIIK WILL BE COMPLIED WITH WHETHEn SpEci FiE0 HEnfIN <br />OR NOT. TIIE GRAN.ING (IF A PERMIT nOE% NOT PRESUME TO <br />GIVE ANY OTHER fAT &OnTIfOFVTY TO VIOLATE LOCALAA ORI`yNCyl`AT /1G PROVISIONS OF <br />CONSTIIUCTION <br />On THE PER RI / Of CfETYSTHUC,.IIPN <br />--' -- — X <br />NK1. CotsSIONA T U IT OF CONT R TO IIOR AVT II. AU T DATE <br />'SLo ONO LAN C/I�iU`ULH rn �nV PLA CIILCK II LI <br />�T F-! EIECCIPT NO <br />/FEES VAL`UATION� FEE__ <br />r <br />IIUILDINO <br />SEPA REVIEW COMPLETE: <br />-J <br />OYES ❑ NO <br />rLSIMnIN(1 <br />conlacl Plannlnq dopl. <br />MLCHANICAI-- <br />OTIIEn <br />r'rUfiLIgNI4lVlru rT <br />lAy)U.I NIUH <br />PENALTY <br />uiMiY1P uT ryLly <br />f- �..r.1(Al <br />I <br />1 <br />• 1 <br />SEC. 303 (A) <br />u <br />;rV <br />