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MAIL ADDRESS ZIP PHONE <br />CbCannbr & ^,ishler Cmat. Inc. 9210 ;sve�IPet^ ?a; <br />;J -/7 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Sara. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Cc <br />W <br />m <br />PERMIT <br />.BUILDING ❑ PLUMBING ❑ MECHANICAL <br />CLASS OF WORK <br />El NEW ❑ADDITION ❑gLTERATION ❑REPAIR <br />z <br />~ <br />VALUATION OF WORK 1J} <br />UU.00 Cy DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK 4 <br />Le-, <br />Cc <br />UJ <br />a <br />��� <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTIOIJ OF PROPERTY (SHOW BELOW OR ATTACH <br />1l7 <br />LOT FOUR,CO'1 ESBLOCK 3 of Intercity Div. 01 <br />T YPE OF FUEL ❑OIL NAT. ❑LPG. ❑ELEC. <br />GAS <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />$ 1 <br />REFRIGERATION UNITS-H.P. EA. <br />- <br />BOILERS-H.P. FA. <br />I <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.IJ. M EA. <br />I <br />JOB ADDRESS <br />9610 Evergreen .lay <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />WATER CLOSET (TOILET) <br />$ <br />INCINERATOR <br />) <br />BATHTUB <br />_ <br />LAVATORY (WASH BASIN) <br />SHOWER <br />--�- <br />KITCHEN SINK & DISP. <br />SUBTOTAL $ <br />DISHWASHER <br />LAUNDRY TRAY <br />PERMIT $ <br />CLOTHES WASHER <br />TOTAL FEE $ <br />I <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 ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />'LIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS'YPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PERMI-F 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 />6/23/77 <br />X <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUMBREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />$ <br />TOTALFEE <br />$ <br />SIGNATURE OF CO NTRACTOR OR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREETSETBACK <br />REARYARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AR EA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP NO. <br />UNITS <br />OF DWELLING <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES MAX. <br />OCC. LOAD <br />BUILDING <br />$ <br />I <br />I <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT FIRESPRINKLERS <br />RCOUIRED <br />DYES ❑NO <br />MECHANICAL <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENELTY <br />SEC. 303(a) <br />1 <br />_ <br />TOTAL <br />I '� <br />I <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />APPLICATION ACCEPTED BY: <br />PLANS CHECKED BY: I APPBOVEBFOBISSUANCE BY: <br />