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I. <br />CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION *BUILDING *MECHANICAL • PLUMBING <br />OWNER MAIL AOUHL!.!1 <br />ZIP v11UNl <br />aces o, F5 ox 7G <br />9�rao_; .�s3'-GJ Oo <br />ARCHIiEL�T UH 0ESIUN R MAIL ADDRESS <br />►HONE LICENSE NO <br />OENLt1AL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NU <br />iojPS Tivc., Po, & �7G`/ <br />�353-d��n Gk�-t�N-Jit1- ./I[I <br />MCHANICAL CON//�9GTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />.1Ll c'7- Aka 6- <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />- <br />-- <br />VIL RMIT <br />CLASS OF WORK <br />Q CQ MBINATION <br />BUILDING ❑ PLUMBING ❑ MECl/ANICAL <br />CIINEW <br />❑ADOITt011 0A,.21tAf1ON ❑IILI'AIII <br />V-CUAf10N OfWORK-- <br />�� <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑'IWIMMINII POOL. <br />DESCRIBE W ORK <br />PROPOSED USE <br />OTHER PERMITS OR APPROVALS <br />�S'L4'iC•�Qr <br />.Q REZONE tj SPECIAL USE <br />}.y <br />t3 SHORLINE <br />LIOAI DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />I OUgc PILSI yt <br />LQId..�Ji.r'g"A ✓it' <br />.VARIANCE <br />LOT BLOCK�OF_L <br />SEPA CHECK LIST REQUIRED <br />= YES <br />yj NO <br />JOB ADon-S <br />MECHANICAL <br />.� �i[ c�_G <br />NUMBING <br />7YPE OF ENERGY Un AB IlI I I C <br />NO. „_ TYPE OF EOUIPME IF _-.-_F[E,___ <br />_ <br />At RCOND. UNil 5-/LP. EA.�� <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />_ <br />qkt RIUFRATION U_NI15.11 P_ LA. <br />� <br />IIAIH 111I CIS 1- <br />BOILERS H.P EA. 1 <br />CLOTHES WASHER OU <br />UISf11VASNE115 <br />-• •' ._.—'—' ----.. <br />iONCEO AIR 6V STEMS B. T. U: ME A. <br />OBINKING FOUNTAINS <br />- •- -•'- <br />SPACE &WALL HE AlENS - R.T.U. I <br />FIOQH DRAINS <br />KITI:HEN SINKS & UISP <br />UNI7 HEATERS B.T.U. <br />IIAII SINKS <br />EVAPOHA11 WE_COOLL14S �� __ �•. <br />II001- DRAINS RAIN TEADLIIS <br />_ <br />CLU TILES DRVknS� 1 ' <br />Y— <br />•Sfif)IVI—H IIA7 H5 <br />tiCFiVICE SINKS <br />SUMPS ._ SEWAGE PUMP <br />_1 <br />VENTILATION FAN _ <br />RANGE HOOD __�Tz�'•� <br />N11 /InNDLINCi UNIT Cd.M. <br />UPINALS <br />1 <br />WATE II CI OSETS <br />I -WATER NLATEHS ELECTRIC )`� <br />- -_ _ ... .. <br />_ WATER HF.A11n ., _�- <br />WASH BASINS - <br />FAC. BUILT rIRLPLACI. W CIIIMNLY _ _ 1 <br />- - <br />LAUNUU Y TITANS ,— <br />GAS. SYSTEM: NO OP OUl'lf IS . .f /��_�_ <br />___ ._. ..._. BULL TorALS•. .. •_•{yIL'V <br />-- <br />SUB TOTAL t i '-- <br />— <br />_._._._TOTAt Ilt <br />- - -- -' - '^ <br />1111! V{iIMIT f1E COWLS NIII 1 ANO VrnU it WIINY. ON CUNST HUC <br />PERMIT S <br />— - -- Ir? <br />TlnN AU fl-DRIM) IS NOT COMAII NCI 0 IVITIIIN M UAV%OR:F <br />A <br />CONSTIl OctION OR WORK 1!I SU:;Iy Nn1:0 Oil Af1ANDONCII FOIL A <br />WATER SERVICE SIZF SUPPLY SIZE <br />PE n100 OF T70 DAYS AT ANY IIMI At tLH WnftK 1!: CTIMLIF NCk b. <br />_BLOB <br />I ILL RLBY CLnTIFY THAT I OAVL HLAO ANII I; CAL11NIn TIIIS AP <br />HLAl1VAHU 5l TUACK� <br />STRLEISLIUACK PLICATION AND KNOW Till SAME TO III TIIUE AND COiOU CT. ALL <br />_' PnOVI!:IONS OF LAWS AND OIIn INANC.ES GOVERNING THIS TIME <br />U 1 <br />OF WORK WILL BE CONIPLIEO WITH WHETHEn SPECIFIED HEREIN <br />U!Sl }UNL WI AHLA 1, ACAN.I Blil — <br />OR NUi. Tllt OnANTING fir A PEnMIT OnE!1 NOt PRESUME TO <br />NO <br />('�'YES []NO <br />AUTIIORITV 10 VIOLAfk On CANCEL fOF PROVISIONS Of <br />ANY 0711ER STATE On LOCAL LAW IILGUL ATINO VONSTIIUCTION <br />f YPE OL CONST. OCCUPANCY GIiUUP NO. Ur DW <br />OR YHE PERFORMANCE Or CONSTHUC110N <br />i <br />�LIING <br />UNITS <br />812OFOLOO. NO. Of STROIES MAX.BCC. LOAD <br />�rCV`r <br />sX n�nrEI�Z:5 <br />1 II/Zf1Nt �� 11 %1:i�i/ZNt /ITII SI'liiK%I lllti <br />2 REOUIIO II <br />�(i ❑Yl!: CI{ND <br />LAN CIILCK NUMIIL If PLAN CIILCK ILL <br />.J <br />I t LL' RECEIPT NO <br />SPECIAL CONUITIONS <br />I <br />E <br />FEES _... VALY U-.rATION/ FEE <br />.-_ <br />I <br />BUILDING S / / I <br />SEPA REVIEW COMPLETE: DYES ❑ NO <br />1'"'"`e1.N." L 11(- <br />Contact Qlannanq dept. <br />.._.__.._ <br />1 <br />MLCIIANICAI <br />1 <br />OTIICR I <br />AHIICAIK1M µbV11YYY r'LANI CMRRIUYY MfKOV��KIbBAM.i YV <br />PENALTY SEC BO]II) 1 <br />I ' <br />TOTAL <br />