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eve rC't* <br /># ulFr.:l1 icvaq <br />4•.I04 <br />BUILDING <br />FLH :•�Ibl <br />Pi. k4vi IT <br />MCCIIANICAL PLUMMING �__•� <br />.VNL17 MAIL AUURL" CIf 1'11U(JL <br />75 <br />I ICHIlEC7 OR DESIGNER MAILADDRESS �` PHONE LICLNSL NU. <br />E�NEITAL CUNTHACTOR h AIL ADDRESS NHONE LICLNhL IJO. <br />a 5"9 C Fay✓�7 <br />rrnlu L.MAIL <br />C:CHA NICA L CO�NToRtiA.CT�F <br />AUUII1L55 PIIUNL LICLNGL NO. <br />a <br />_UMUING COUIRACTOR MAIL ADDRESS PHONE- LICENSE NO. <br />LU <br />m <br />=RMIT .,._ <br />]:aU:LDItJG ❑PLUMBING ❑MECHANICAL <br />CLASS OF -WORK <br />tJEW ❑AOC.TION ❑ALTERATION ❑REPAIR <br />Z <br />f- <br />G <br />ALUATI I OF Y.ORK <br />j <br />(O <br />❑DEh'OLISH FENCE ❑SIGN ❑$Wt01MING POOL <br />cc <br />CL <br />ESCRIBE YY: <br />RS�V, <br />(011usED USE <br />MECHANICAL <br />TYPEOFFUEL ❑OIL ❑NAT. ❑LPG. (JELEC. <br />GAS <br />.GAL OESCP:JTION OF PROPERTY (SHOW BELOW OR ATTACH <br />'UR �COPIIEES, <br />)T—SLR.._ BLOCK�OF _ <br />,./ n •, <br />✓T��/ 1T'�IIS o y � sle 0_0 <br />NO. <br />tf <br />TYPE OF EOUIPEN7 <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S i <br />%IEFFlIGE RATION UNITS-H.P. EA. <br />_ __ <br />—T <br />BOILERS-11. P. 1: A. <br />I <br />- - L.r 06S <br />GAS FIRED A.C. UNI TS-TO FINAGE EG. <br />- <br />FORCED AIR 51 STEf.!S-Q.T.U. A7 EA. <br />I <br />6 ADDRESS <br />' <br />WALL HEATERS—O.T.U. III <br />UNIF HEATERS-B.T.U. hl <br />I <br />.UFJSBING <br />EVAPORATIVE COOLERS <br />_ <br />CLOTHES DRIERS <br />I <br />VENTILATION FAN <br />_ <br />9 <br />RANGE HOOD <br />I <br />AIR HANDLING UNIT- C.F.M. <br />). <br />TYPE OF FIX TURE OR ITEM <br />FEE <br />INCINERATOR <br />I <br />1VATEP.CLCSET(TOILET) <br />S <br />_ <br />UATt{TU3 <br />_ <br />LAVAiOiY MASH BASIN) <br />SHOWER <br />KITCH-c.% SINK & DISP. <br />_ <br />SUBTOTAL S <br />I <br />._ <br />Off."WA5JIER <br />{_ <br />-- PERMIT S <br />LAUNDRY TRAY <br />TOTALFEE S <br />I <br />CLOTHES :: A>HER <br />THIS PERMIT BECOMES NULL AND VOID IP WORK OR CGNSTRUC- <br />PION AUTHORIZED IS NOT CO%%.MENCED :%ITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY Tlf.iE AFTER WORK IS COMMENCED. <br />1 HEREBY CERTIFY THAT 1 t1AVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOW THE SASIE TO BI TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TWS TYPE <br />OF WORK WILL OE LOhtPLICD AITH LVHETHER SPECIFIED HEREIN <br />OR NOT, IRE 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 PE F-O RMANCE OF CONSTRUCTION. <br />X _ U <br />SIVATCTU.M, CONTRACT 1ORAUTH. AGENT -vAlc <br />WATER HEATER <br />URINAL <br />f <br />DRINKI•:G FOUNTAIN <br />FLOOR-S:%K OR DRAIN <br />VACUUM: 91AKCnS <br />ROOF GS-0'.'<$�RAIN LEADERS <br />_ <br />SINK (SEFVICE-OAR_ETC.) <br />i <br />SUBTOTAL <br />PERMIT <br />5 <br />TOTAL FEE <br />S <br />'ITY <br />USE BELOW THIS LINE <br />+E VARD SETBACK <br />- <br />STREET SETBACK <br />HEAR YARD SETBACK <br />PLI N CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />E ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES [:)NO <br />FM, <br />VALUATION <br />FEE <br />PE OF CONST. <br />OCCUPANCY GROUP 140. <br />OF DWELLING <br />UNITS <br />1 <br />1 <br />BUILDING <br />5 <br />I <br />E OF ULOG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />IE ZONE UASLh1LNT LI IOUMENK LEIlS <br />R U DYES <br />YES ONO <br />- CIAL CONDITIONS: <br />MECHANICAL <br />I <br />OTHER <br />1 <br />1' <br />PENELTY <br />SEC. 000(e) <br />—'T— <br />TOTAL <br />— 1 — <br />1 <br />PEFIMIT VAIJDATION <br />IVHLN I ROPL RLY VALIDATE.) ON TIII.^. SPACE) THIS IS YOUR PERMIT <br />�6A hUb LlCV 1+P Ol I'l I1H: Lull LI II PY. AI'vUnvl°IU.I P:U�L�.I IIY <br />I <br />