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CI: Y HAI_L �b'1 }1/4G <br />t.vr_iei,rr.wn o��zui COM8INATION • BUILDING • MECHa,.^!IC�1L • PLUMBING <br />ow�.tr� ^nni�r.uui�Lss zir vnuw- <br />:,i' P40ol�i� 353-3FQ1 <br />—' --- --- — ------ --- ------- — <br />l�Ii:HI'IFCTJRUE9GNLH p9A;I.ADOIlC55 PI:JNL LICFNSE <br />GfNldlil�LCONTRACI'OR MAILADDRESS PHON@ LICFN::t <br />AODfl <br />PLUMIIING CONTRACTOR MN� ADDfiE55 PNONF. LICENSE N�. <br />P[RG 7 CL;.SSOFWORK <br />� CON�BINATION <br />[�(3UI�DING �PLUM[31NG ❑MECHiIIJICAL <br />[�'NF.W ❑AGLITii�N �ji�LTEH.ITIUN UR[PAIF <br />V11LUAl ION OF WORK � � <br />5 — -- � ❑DEMOI.ISH ❑FENCE ❑SIGN ❑SWIMMING POO! <br />OESCPI[3E WORK <br />:�IIdI—Si'�^1iG� i3LD(}. D—�. <br />raoPoseo use <br />MECHANICAL <br />SAj T <br />TYPE OF GN[HG V <br />OF PROPERTY �SIIOW UEL�- nq ATTACH []G ❑E EC <br />LOT �LOCK— <br />ti-T l /� l 7_9ii—(l�r <br />JOf3 ADDRESS <br />PLUMBING <br />E <br />9E3o �:�; .c*�e;�; �rnY <br />AS L . <br />NO. TVPE OF EQUIPMENT FEE <br />AIR COND_UNITS-II.P. EA. 5 I <br />RC-fRIGEHATIGN UNITS--N.P. [A. —r-- <br />--_ � <br />❑OI�ERS-H.P. EA. � <br />PORCED AIFl SVSTEMS-6.T.U. MEA. —� <br />'_ __ '_ I <br />SPACE & WALL HEATERS - B.T.U. <br />__ 1— <br />-~UNIT HGATFRS- B.T.U. I <br />[VI�PJRI�TNE COOLERS � <br />c�o riies or6veas i <br />VLNTILATION FqN �— <br />HANGE IIOOD � <br />Alfi HqNDUNG UNIT- CF.M. <br />'_'—_ I _ <br />WATER HEATER <br />PAC. 6UILT FIqEI'LACE & GMIMNEV � <br />l:`15. SVSTEM: NO OP DUTLETS �— <br />_ _ _ —_— _— _ _____"'_"._"__'_— � <br />___1__"_____ SUItT07AL _ I <br />PFRMIT s —� <br />TOTAL FEE 5 � <br />THIS VEFMIT U[COMES NVLL AND VO10 IL WORK OR CONSTRUG <br />TION nUT11pHIZEf� I� ;'OL COMMENCEC WRHIN 120 DAYS, OR IP <br />CUNSTRUCTION OR WORK IS SUSPLNDEU OR 40l�NDONED FOft A <br />PERIOD Of 120 DAYS AT AN� TIME APTEH WOfiK IS f.7MMFNC[D. <br />I HER[OY CERTIf-V THAT I IiAV[ RC:AU ANO EXAWINED THIS l�P� <br />PLICf�T10N P JD KNON' TIiL SAME t0 �6 TRU[ 11NO COriHECT. ALL <br />PROVISIUP', OF LAWS ANO OFiDINANCES GOV[flN�NG THIS TVPE <br />OF WORK WILL [3E COMPIJE[� WITH WIIETHER SPhCIPIE� MEflEIN <br />OR NOl', THE GHANTING O� A PERM19IT C10E5 NOT PNESUtAE TO <br />GIV[ AUTI-IOfiITV TO VIOI.M'E OR CANCEI. THE PqOVI510NS OF <br />A:VV OTHER $TATF OR LGCAL LAW ft[ciL'LATiNG CUNS�f(il�rTION <br />Oil THE PERFORMANC[ OF CONSTRUCTIOtJ. <br />T— 70TAL FEE c--t--� x L'Y C??;CI'i 7O%y.j <br />TERSEflVICESIZE BLDG.SUPPLVSIZG SIGNnTUR@oPCONTRnCTORO <br />)EVAR�SETl3ACK STREETSPI�BACY, RLlliYMOSfT(3ACKPLl1NCHECKNUMRER <br />Tl/�L T'�/� JT/n f-[E <br />E ZONE LOT 11HEq VACAM� SITE <br />C-1 C11'ES ❑No FEES <br />EM1 <br />NO <br />SPECIAL CONDITIONS: <br />YES <br />ncavnuim. vinrvsa�ec�iuur nrrnov�nroinre;�.�nna uv <br />�) <br />.AGLNT DATE <br />PLAN CHECK FEE <br />IRGCEIPT NO. <br />VALUATION _� FEE <br />� <br />GUI�DING $ —� �_�� ���� I <br />Ltl! <br />—T'— <br />PLUM�ING � <br />I <br />MECIiANICAL { <br />OTHEF I <br />I <br />P[NALTV SEC.JO:IIaI I <br />_—____ _—�_— <br />TOTAL I 1� OO <br />PERMITVALIDAI'ION DO �� � �'O��Y\�'-1f" � � <br />WHfNPIiOPEHLVvnLIUM[o11N � I� nC[1 RTtS11T <br />YOl1R REC:EtPT <br />. TNANK '(O U <br />-8s�'71 <br />