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- C01"STRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHA141CAL • PLUMBiNG <br />OWNLH MAIL ALL"L ; LIY YHUL <br />N,gclw -2?6 17o45 <br />AFCHITE CIUH DESIGNER MAIL ADDRESS <br />PAUNL LICENSE O <br />3� �✓Ei /Go NvvGiu✓va�/ ��s��i+�-� 3SaGszz /G89 <br />GE N L R A L C D NY R ACT O R MAIL ADDRESS <br />PHONE LICENSE NO, <br />MECHANICAL CONTRACTOR MAIL ADORES <br />- PHONE LICENSE NO. <br />F-UMPING CONTRACTOR MAIL ADOnESS <br />PHONE LICENSE NO. <br />►EnMli LT/Tf/ �/A6 <br />V7i <br />CLASS OF YIORK <br />❑COMBINATION <br />❑ BUILDING ' ❑ PLUMBING ❑ MECHANICAL <br />❑NEW <br />❑ADDITION -] ,.T LIIA TI4IN ❑ii(1•n VI <br />VALUATION OF WORK <br />----�----�-�— --- <br />❑DEMOLISH <br />❑FLNCE ❑SIGN ❑SWIMMING POOL <br />S <br />DESCHIOE WORK <br />7z74%f,C,F,� H(4"-js'CI fw <br />PROPOSED USE <br />OTHER PERMITS OR APPROVALS <br />rlRE ZONE tj SPECIAL USE <br />LkGAL DFSC RIPTION OF PROPERTY (SHOW BELOW On ATTACH <br />Fours cop lLSl <br />+� <br />#�-i VARIANCE SHORLINE ... <br />`LOT BLOCK —OF <br />SF PA Ct,FCK LIST REQUIRED <br />DYES <br />II NO <br />--- <br />'JOB ADDRESS <br />MECHANICAL <br />PLUMBING <br />TYPE. OF ENERGY <br />01: AS ❑FLEX. <br />NO. TYPE OF EQUIPMENT FEE <br />_ _ _ ---- —--- •—t$-��---- -- <br />AIR COND. UNITS-1LP. E0. 1 <br />_ <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />ntF RICERATION UM(S uP. CA' —_T <br />14A1H IIIHS <br />$_ _ <br />---L <br />SOI(ERS 14.P.(A.----------�---� I <br />UtOTHES WASHER <br />DISH WASHERS <br />I <br />I <br />FORCED AIR SYSTEM, B.T.0 MEA. <br />-'---- --- --------L-- <br />IRINKING FUUNTAINS <br />Ft OOR DRAINS <br />I <br />SPACE d WALL HEAVERS R.T.U.I— <br />KIICHEN yYNKS & UI SP <br />—_T <br />UNIT "CATERS H.T.U. 1 <br />RAH SINKS <br />I <br />EVAPORATIVE COOLERS �— <br />- ----_-- -- <br />ROOF DRAINS RAW LEAVE HS <br />—� <br />CLOTIICS DR YE RSI <br />SHOWER HATHS <br />- <br />ENTI LATIO:V FAN —r-- <br />SEHVICE SINKS <br />-' --T---•� <br />RANGE HOCID <br />SUOPS -- SEWAGE PUMP <br />-- <br />URINALS <br />I <br />__ AIF. HANDLING UNIT'-+ .--.- C.F.M. <br />-- ------ - -•- — <br />_ <br />MIER CLOSETS <br />_ <br />_ ____. ----- —.. - _. __. .. _ •_ — I <br />-'-- <br />EIni�E:-E <br />WATER14EA1'CTRIC <br />I_ <br />WATER HEATER _ T— <br />._ - --. <br />WASH BASINS <br />_ <br />-~ <br />FAG BUILT FIREPLACE h CNIMNEV 1 <br />LAUNDRY TIIAYS <br />T— <br />_ <br />_ ('VAS. SYSTEM: NO dP OV 7LI �1S - _• _ �_— <br />-- .__. — .. •.GUn <br />_ <br />TOTAL S I <br />PERMIT .—S.•.--_� <br />SUn TOTAL <br />— I <br />----_— _---- tOTAL FCC S I <br />-THIS <br />PE II MIT <br />S----I— <br />T%n 1II DM ES L nND VOID II WORT; fi1NSTR <br />NOT D WITHIN <br />AUTHORIZED NOT 0 <br />VO DAYS, OR IF <br />I <br />USPI <br />' TOTAL FEE <br />S <br />CONRCTIONOWS <br />!; ND RAll <br />CONSTRUCTION OR WU Ra I;; SU!:P!'NDET) OR nf1ANDONEU FOR A <br />WATER SERVICE SIZE SLOG. SUPPLY SIZE <br />PLmoD or: 170 DAYS AT ANY TIME AF TEII\Y()RK II;CONIMENCLU. <br />-. (JACK <br />fit AfI YAHU St IBACK <br />I IIEREBY CERTIFY THAT I HAVE READ AND E`(AMINtn TIR.; AR <br />PLICATION AND KNOW IRF SAME TO RL TRUE ANO CORRI Cr. ALL <br />PnnVI51DNS OF LAWS ANO ORDINANCES GOVERNING T141S TYPE <br />OF WORK WILL BE COMPLIED WITH W'HETHEH SPECIFIED HEREIN <br />USL Z(1NL LO/ A"LA VACANT SITE T- <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTIIORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />DYES ONO <br />ANY OTHER STATE On LOCAL LAW RLGL/LATIN(I CONSTRUCTION <br />TYPE OF CONSI. OCCUPANCY GROUP NO. OF OWE LLING <br />UR THE PERFORMANCE OF CO NS 111VClION , <br />UNITS <br />SIZE OF SLOG. NO. OF STORIES MAX. OCC. LOAD <br />{114k Z(INI. IIAGt MLNI /IIlE .'�I'IiINK LL II'. <br />S I G N A T U I A E OF C O N T n A C TO T 14. A G, L N T DATE <br />RE0UIfiLU <br />❑YtS ONO I <br />I'LAN CHECK NUMBER I PLAN CHECK ILL <br />IFEE RECEIPT NO <br />SPECIAL CONDITIONS. <br />%716 Y7 <br />-- 7 47bflwV- �lr-& <br />n (=-Cf YpS <br />FEES I VAWATION FF.E <br />_ <br />BUILDING _ I <br />SEPA REVIEW COMPLETE ; ❑YES <br />NO <br />PUIMmNa <br />contact planninq dept. <br />MLCHANICAL I <br />- <br />OTHER I <br />i <br />