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� [he fi�crqrecn ' � � <br /> ; =�i� �F GONSTRUCTION evere�c i � <br /> � ev�rett PERMIT <br /> � Cii1 NALt )y9ABP: <br /> fV[�[11 NAp�INGipN <br /> I 9F.+01 <br /> , n�ri �,� �o„M���r. gUILDING MECHANICAL FLUMBING <br /> L[VLLO�MLX1 <br /> OWNER MAIL ADDiiE55 LP PHONE <br /> � LaroyCCarter �7.37 9r�advray S'82•J1 2�2-1755 1113--7"? <br /> AFCNIIECT OH DESIGNEF MAIL ADDFE55 PMONE LIGENSE NO. <br /> GENEHAL CONTRACTOR MAIL ADORE55 PHONE LICENSE NO. <br /> � �ivoraiQe 3touf n 1522 :?alnat 252-7950 2I-Vl:-RR-3�2"r <br /> MECHAN�CAI CONTRACTOR MAII ADDHESS VHONE LICENSE ND. <br /> � PLVM�ING CONTflACTOR , MAIL ADDRE55 P/IONE LICENSE NO. W � <br /> m <br /> � <br /> PERMIT CLASS OF WORK � <br /> Z <br /> [�BUILDING �PLUMBING �MECHANICAI F� <br /> ❑NEW ❑ADDITION ❑ALTERATION �REPAIR � <br /> VALUATION OF WORK 2 <br /> s 3O�wOD ❑DEMOLISN ❑FENGE ❑SIGN ❑SNIMMINf POOL � <br /> DESCRIBE WORK <br /> IDoof repair o! axisting ioof 2948 <br /> Paoroseo �se MECHANICAL <br /> lEGALDESCRIPTIONOFPROPERTYlSMOWBELOWORATTACH T�PEGFFUEL �OIL �Gn1. �I.PCG. �ELEC. <br /> PI:VR COPIES) <br /> Lo7 BLOCK—oF NO. _ TYPE OF EQUIVMEN7 FEE <br /> AIR CONIJ. UNITS-H.P. EA. S � <br /> REFRIGEPATION UNITS-H.P. EA. <br /> OOILERS-HP. EA. I <br /> GAS f IRED A.C.UNITS-TONNAGE EA. <br /> FORCEU AIR SVSTEMS-B.T.U. M EA. I <br /> JOB AD�R 5 WALI HEATERS-9.T.U. M � <br /> IZZ� araadvep VNITHEAlERS-B.T.U. M 1 <br /> E V AVORAT I V E CODLE IiS �— <br /> PLUMBING CLOTHESORYERS i ' <br /> VENTILATION FqN <br /> RANGEHOOD 1 <br /> NO. TVPE OF FIXTURE OR ITEM FEE A�A NANOLING UNIT- C.F.M. <br /> WATERCLOSET�TOILET; g �NCWERATOF I ' <br /> _� <br /> Bl�TNTUO � � <br /> LAVATORVIWASHBASIN) I <br /> $IiOWER <br /> KITGHEN SINK& DISP. SUB TOTAL 5 � � <br /> � DISMWASH@fi pERMIT $ <br /> LAUNDRV TfiAV TOTAL FEE $ � <br /> G�OTNES WASNER TNIS PEFMIT DECOMES NULL AND VOID IF WORK OR CONSTPUC <br /> WATEfi HEATER TION AUTHORI2E� IS NOT COMMENCED WITHIN 120 OAVF, OR IF <br /> URINAL � CONSTRVCiION OR WORK IS SUSPENDED OR ABANDONflD ron n I <br /> OPIfJKING FOUNTAIN PERIOO OF 120 DAVS AT ANV iIME AFTER WORK ISCOMMENCED. <br /> FLOOR-SIIJK OR ORAIN I HE iEBV CERTIFV THAT 1 4AVE FEAU AND E%AMINED THIS AP- <br /> VACUUM fiREAKERS PLICATION ANO KNOW THE SAME TO �E 7 RUE AND COfiFECT. 4LL <br /> ROOF UFAINS-RAINLEADER$ PROVISIONS OF LAWS AND CfiDINANGES GOVERNING THIS TYPF <br /> CF WORY. WILI BE COMPLIEU WITIi WHETHER SPECIFIED NERE!N <br /> SINK (SERVICE-BAR, ETC.1 OR NOT, THE GPANTING OP A PEFiMIT 60E5 NOT PPFSUME TO <br /> - GIVE AUTHOPITV TO VIOLATE OR CANCEL TFIE PROVISIONS OF <br /> ANV OTHEF STATE OR LOCAI LAW FEGUTAlING CONSTRUCTIGN <br /> OA THE PERFORMANCE OF CONSTiiVC�ION. <br /> SUB TOTAI. <br /> PEqM1T S <br /> TOTAL FEE S _�— �q(jk �� j1J3 7Iz�I?7 <br /> X <br /> SIQNATUFlEOFCONTAACTORORAUIH.AGENT D/aTL <br /> SIDE VARD SEi[lACK STREET SET�ACK HEAR YAF�SET9ACY PLAN CHECK NUM�ER VLPN CHECK FEE <br /> FEE iiECE1PT NO. <br /> VSE20NE LOTAREA VACANTSITE <br /> ❑rES ❑NO FEES VALUATION F[E <br /> TVPE OF LONST. OCCUPANCV GROVP NO.OP DWELUNG <br /> UNITS 1 <br /> 512EOFBL.DG. NO.OFSTORIES MAX.00C. LOAD BUIL�ING $ S�JO�OO � QD <br /> P W MBI NG � <br /> f�IREZONE BASEMENT FIRESPAINKLERS <br /> RC�V19E� <br /> ❑VES ❑NO MECHANICAL � <br /> ISPECIALCONDITIONS: OTHER � <br /> I I <br /> PENELTY SEC. 3031e1 I <br /> TOTAL <br /> PEFMIT VALIOATION <br /> WHEN PROPERLV VALIDATED IIN THIS SPACE)THI515 VOUA PERMIT <br /> ePvl�CTtO�IACCFP1E08Y' FIANSCNECKCUBY: IPi'POV(OtOhI55U�NCEE: <br /> �.I.��j• <br /> 3 <br />