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DIY IIAH MIA <br />IYI II II, nl:•.41dull <br />IIRI <br />OUT. orIt'i',Zly BUILDING <br />0,.11'.IVI Yi t' OIL <br />W%al U%/ t It V I I Vs v <br />ML"CHANICAL <br />PLUMBING <br />V YINLH MAI AUUHLUS �LIP PHUNL <br />p ' / , �F,,i o rY�D <br />ADDRESS �/ ON' LICENSE <br />AIICIIITEC OR OCSIfi � AIL AUUII PHE NV. <br />'S /- ,7 <br />S//g/%/ <br />K <br />GENERAL CUIITRACTOR ��. MAILADOIIESS YIIONE LICENSE NO. <br />�� o <br />MECHANICAL CONTRACTOR MAIL ADUI1kSS .. PHONE LICENSE NO. <br />I'LUMUING CONTRACTOR MAIL ADOHESS PHONE LICENSE NO. <br />W <br />SO <br />PERMIT <br />AeC P/q to <br />OUILnIND C] CHANICAL <br />CLA55 OF wonK <br />[I NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />D <br />- <br />VALUATION OF WORKO: <br />❑DEMOLISH FENCE ❑SIGN []SWIMMING POOL <br />W <br />DESCRIB W RK ,Al �Q <br />PROPOSED USE <br />MECIIANICAL <br />TYPE OF FUEL ❑OIL ❑GAT• ❑LPG. [JELEC. <br />LEGAL DESCRIPTION OF PROPERTY ISIIOW BELOW OR ATTACH <br />FOUR CO IESI -7 <br />LOT ELOCK?�OF��'LZ <br />' <br />' <br />NO. <br />TYPE OF EOUIPh1EN' <br />FEE <br />AIR COND. UNITS-11.1'. EA. <br />S 1 <br />REFRIGERATION UNITS-11.P. EA. <br />BOILERS-H.P. EA. <br />1 <br />• <br />GAS FIRED A.C. UNITS-TONNAGC EA. <br />FORCED AIR SYSTEMS-R.T.U. MCA. <br />I <br />JOB ADDRESS -� M���� <br />•[ �(�-3 J�C U �"'"'"'IT.UO <br />WALL HEATERS-O.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />' <br />VENTILATIO14 FAN <br />RANGE HOOD <br />I <br />AIR HANDLING UNIT— C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />T— <br />INCINERATOR <br />WATER CLOSET ITOILETI <br />5 <br />BATHTUB <br />LAVAI ORY (WASH UASINI <br />- <br />1 <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUBTOTAL S <br />I <br />DIGHWASI!ER <br />PERMIT s <br />LAUNDRY TRAY <br />TOTALFEE 5 <br />1 <br />CLOTHES I'.ASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC• <br />TION AUTHORIZED IS NOT CO-MMENCED WITHIN 120 DAYS. OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTERWORK IS COMMEN.ED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND r.NOW THE SAME TO PC TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL OE.COMPLIEO WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PBRh11T DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />_ ZAR <br />5I NOFCONT RACTOR OR UTH. AGEIJT -U It! <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />1 <br />FLOOR-S'N'K OR GRAIN <br />VACUUV '9EAKERS <br />ROOF GR�":5-RAINLEAOF.RS <br />-- <br />SINK (SEFVICE-OAR ETC.) <br />_ <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />$1 <br />CITY <br />USE BELOW THIS LINE <br />SIUEYAROSETSACK <br />SI'REETSCTBACK <br />HEAHYARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS OWE L LINO <br />1 <br />BUILDING <br />s I (,.)` i�.. OC-1 <br />1 <br />1 �� <br />SIZE OF DECO. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />1 <br />FIRE ZO NE <br />(A EEh1LNT <br />f IIIL S P R I N K L E IIS <br />REQUIRED <br />❑YES ONO <br />MECHANICAL <br />1 <br />GPECIAI. CONDITIONS: <br />OTHER <br />I <br />I' <br />PENELTY <br />SEC, 3031.) <br />I <br />- — <br />TOTAL <br />PERMIT VAI.IUATIUN ' <br />WHEN 1-1101-L HEY VALIDATE.) (IN TIII SSPACE) 7111S IS YOUR PCIIMIT <br />n r. <br />�- <br />nl'1'l4dlrtitl M[Ir11JF1' nlnN: Lpl )e1R0Y; nl)i•Iinv11111711S.unlxl llY <br />-------- _ <br />/I'rLILAN T'C. COPY <br />