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i .,.�,:::� ,....... � <br /> � [VCflCii.A9ASIIINfdOq � <br /> 99i01 <br /> °�"' °`�°"''°""� BUILDING MECHANICAL PLUMBING <br /> n[v[�ovnicxr <br /> OWNER MAIL A�OFESS 21P PHONE <br /> 1�r�`�,� 1�!'�'i!''r�'}�j r�'�-"��' <br /> 3'�= s� <br /> AflCHITECT OR�ESIGNER MAIL AODRE55 PHONE LICENSE NO. <br /> GENERAL CONTRACTOR MAIL AD�RESS PHONE LICENSE NO. <br /> 'ti:"-nz r_a,'-^-�3 <br /> MECHANICAL CONTRACTOR MAIL ADORESS PHONE LICENSE NO. <br /> PLVMOINGCONTRACTOR MAILADDRE55 PHONE LICENSENO. � <br /> W <br /> •T';fjY`+:j.',',"^x .�fv�i• f� <br /> PERMIT CLASS OF WORK � <br /> z <br /> ❑DUILDING �]PLUMBING �MECHANICAL �NEW ❑AD�ITION ❑ALTERATION ❑REPAIR ~ <br /> S <br /> VA�VATION OF WORK � <br /> ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL W <br /> 5 G' <br /> OESCRI�F WpRK t9 y� �O(� <br /> �yl,.'a��*,,. :�':�. �`' G''..RS:r�': h�Jti u��i�; :�•3:7i3s <br /> \j{� <br /> PROPOSE�USE MECHANICAL <br /> TYF'EOFFUEL �OIL ❑Gn5 ❑LPG. �ELEC. <br /> LEGAL DESCftIPTION OF PROPERTV (SHOW BELOW OR ATTACH <br /> FOUR COPIES) <br /> NO. TYPE OF E�UI�'MENT FEE <br /> LOT BLOCK__OF AIR COND. UNITS-H.P. EA. 5 I <br /> REFRIGERATION UNITS--H.P. EA. <br /> BOILERS-H.P. EA. I <br /> GAS FIRED A.C. UNITS-TONNAGE EA. <br /> FORCED AIFi SYSTEMS-B.T.U. M EA. I <br /> J06 ADDRE55 M1�� WALL HEATERS-�.T.V. M <br /> � � ��^� ��h� UNIT HEATERS-�.T.U. M I <br /> lqiJ'+r .,. .. <br /> LVAPOFATIVECOOLERS <br /> PLUMBING CLOTHES OftVERS I <br /> VENTILATION FAN <br /> RHNGEHOOO � <br /> D. TYPE OF FIXTUREOR ITEM FEE AIR HANDUNG UNIr- C.F.M. <br /> WATEF CLOSETITOILETI ,S �NCINERATOR � <br /> �ATHTUB <br /> LAVATOR�'(WASH BASIN) � <br /> SHOWER __ <br /> KITCHENSINK& DISP. SUBTOTAL 5 � <br /> DISHWr15HER PERMIT 5 <br /> LAUNDPY TRAY TOTIIL FEE S I <br /> CLOTIIES WASHER THIS PEPMIT �ECOMES NULI ANO VOID IF N/0RK OR CONSTRUC� <br /> WATER HEATER TION AUTHORIZED IS NOT COMMENCED WITHIfJ 120 DAYS, OR IF <br /> UR�NO.L CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A � <br /> DRINY.ING FOUNTAIN t <br /> PERIOn OF 120 DA'�5 AT ANV TIME AFTEP WOftK IS COMMENCED. <br /> FLOOR-SIPIK OR DRAIN I HERE6Y CERTIFV THl.T I Hl�VE READ AND EXA�dINED THIS AP- <br /> �""-�-'�-'—'--�' -"—--�—I--- YLICA'1'ION AND KNOW THE SAME TO�E TRUE AND CORRECT. ALL <br /> VACUUM 6FIEAKERS p�iOVISIONS OF LAWS AND OROINANCES GOVERIJING THIS TYPE <br /> HOOP ORA�NS-FAINLEADERS OF WORK WILL 9E COMFLIEO WITH WHETHER SPECIFIED HEREIN <br /> SINK(SERVICE-6AR, ETC.) OF NOT, TF1E GRANTING OF l� PLRMIT DOES NOT PRESVME TO <br /> GIVC- AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �— ANV OTHER STATE OR LOCAI LAW REGULATING CONSTPUCTION <br /> OR l'HE PERFORMANCE OF CONSTRUCTION. <br /> SUB TOTAL �+���_ <br /> PERMIT 5 .,� . <br /> TOTAL FEE _ 5 �'7_� <br /> � X `-Fi'' �'zbr,�i �2�� . '�i <br /> SIGNATUFEOFCONTRACTORORAUTH.AGENT DATE <br /> SIDE YARD SETBACK STREET SETBACK REAR VAFDSET6l�C PLAN CHECK NUh10ER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> US[ ZCNE LOT AREA VACANT SITE <br /> ❑YES ❑No FEES VALUATION FEE <br /> TVPE OF CONST. OCCUPANCV GROUP UNIOS DWELLING � <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC. LOAD BUILDING S � <br /> I <br /> PLU!161NG ��� — <br /> FIREZONE BASEMENT ftfQl�iflEDKLEflS � <br /> ❑YES ❑NO MECHANICAL 1 <br /> SPECIAL CONDITIONS: OTHER � <br /> I <br /> PENELTV SEC. 3031a) I <br /> TOTAL �I� <br /> PERMIT VALIDATION <br /> WNEtt PftOP[RLY VALI�ATED(IN TNIS SPACE)THIS IS VOUP PERMIT <br /> pPPU[ATIONACCEPTEOOY: PLANSCHECKED�Y: P>PqOVEOGOPIS`.UANCEBY: <br /> 1_ s <br /> I x ..� � <br />