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9e]m <br />°EP COMMUNITY DEVELOPMENT PMEN BUILDING MECHANICAL PLUMBING <br />CT.�Bt: /#'mod• Q ]gC.F <br />ARCHITECT OR CESIGNER <br />ZIP - PHONE <br />PID !-. 4.= T- UM 1�: '��t':AICR' 9a0tt3 <br />MAIL ADDRESS PHONE LICENSE NO. <br />22is-7G <br />GENERAL �COF�N.TRACTOR <br />Mapvm <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />W <br />PERMIT <br />CLASS OF WORK <br />m <br />2 <br />0 <br />(TSUILDING PLUMBING <br />❑ ❑MECHANICAL <br />El NEW <br />VALUAI JU�yN�Ul-�LWryOOR��K <br />S :TA (* ❑DEMOLISH <br />®ADDITION ❑ALTERATION ❑REPAIR <br />❑FENCE ❑SIGN ❑SWIMMING POOL <br />z <br />� <br />cc <br />W <br />DESCRIBE WORK yyv��.pII�j��a� }�� ���/ r.���p�•��.r <br />b•SiT'.4SS/ (pyT,�t�i fa-' r. ii ^?� EFO+!♦: WY <br />125 <br />D- <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUgCC�PI4ES ) <br />TYPE OF FUEL ❑OIL ❑NAT. ❑LPG. ❑ELEC. <br />GAS <br />LOTL BLOCK_OF_ <br />WE > p�.r i� <br />NO. TYPE OF EQUIPMENT FEE <br />AIR COND. UNITS-H.P. EA. $ I <br />REFRIGERATION UNITS-H.P. EA. <br />_ <br />BOILERS-H.P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />JOB ADDRESS <br />T44V <br />qw8 va <br />ORCED AIR SYSTEMS-B.T.U. M EA. <br />WALL HEATERS-B.T.U. M <br />�MiF <br />UNIT HEATERS-B.T.U. M I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYEPS 1 <br />VENTILATION FAN <br />RANGE HOOD <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR Hn NDLING UNIT- C.F.M. <br />WATER CLOSET (TOILET) <br />S <br />INCINERATOR <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />1 <br />KITCHEN SINK & nISP. <br />SUBTOTAL $ <br />I <br />DISHWASHER <br />LAUNDRY TRAY <br />PERMIT S <br />CLOTHES WASHER <br />TOTAL FEE S <br />WATER HEATER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT A,NIY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PERMIT 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 P:-RFORMANCE OF CONSTRUCTION. <br />x }8 3763 <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />— <br />SUB TOTAL <br />PERMIT $ <br />TOTAL FEE S <br />SIGNATURE OF CUNT RACTORORAUTH—AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />TYPE Of CO NST. <br />CCCUPANCV GROUP <br />OYES ONO <br />NO.OF DWELLING <br />UNITS <br />FEES <br />VALUATION <br />FEE <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />S 000600 <br />2YML <br />PLUMBING <br />1 <br />FIRE ZONE <br />BASEMENT <br />FIRESPR INKLERS <br />REQUIRED <br />YES ❑NO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />1 <br />PENELTV <br />SEC. 303(a) <br />I <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />APPLICATION ACCEPTED BY: <br />it CIO <br />PLANS CNECKEDBY: <br />fret Cvr I <br />APPROVED FDA ISSUANCE BY: <br />xw fo <br />3 <br />