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- CONSTRUCTiON � , , <br /> �:� i <br /> PERMIT ApPL(CATiC�N ��'z � � <br /> � <br /> COMBINATION • BUILDING • MECHANICAL • PIUMBiN^- � <br /> ( as a- �s�-31 , <br /> OWNt1/ MAILAOUHl:.0 !IY /� MHUN! /� <br /> �3�.�PS�I_rel a ��P IAI:Z�� (7 ,� �G13 V'S 'E � <br /> APCHITECT UN DE51(:NtH MAILADDHE55 PNONE . LICENSt NU <br /> GEN[RA��pNTi1ACTOR (�� MAILAODHESS PMONE �/ LICENtiENU. . <br /> �i i l'cVJ �i�� ISC)1�f� r! . . , ; ' . <br /> MECNANICA�CUNTRACTOR ' NAII ADOf1E55 PHONE � . UCENSE NO. <br /> PIUMtl�NGCONTRACTO� MAILADORE55 OMONE L�CENSENU. ' <br /> YlHMIT � CLASSOFWORK ' . <br /> p❑�COMBINATION . ' <br /> �p.0U1LDINC � PWMUING �MKHANICAL �( <br /> ❑NEW {�ADOITION ❑AITEliAf1UN ❑i1C1'n111 <br /> VALUATIONOF WUFIK ❑$IGN ❑'i1VIA1MINfi P(IOL <br /> S �DO . 00 ❑DEMOLISM ❑FENCE . <br /> DESCRI6E WORK n � <br /> Fi c.MC' �i' r.c�tCoi•� l�PC ��U�� <br /> rAoroseouse OTHERPERMITS ORAPPROVAlS . <br /> ,�S_>,��ji,L ��� �1 REZONE � SPECIAL USE <br /> FOVR COPIt51�PTlOt1 OF PfiOPERTY ISHOW 6ELD1V OR ATiACN a <br /> �$VRRIANCE �� SN.ORLINE <br /> LOT BLOGK_OF <br /> 1 / � r� 5 E�P YE HECK LIST REQUIRED <br /> S e�.�h /.,� o-�- "� � _ <br /> .1''..l NO , <br /> ,o�oo�Ess�— S n0 ho rn�5 h L`PP� U � — <br /> ''fFf3S �IP/�k� Ue a 'y �MECHANICAL � <br /> PLUMBING - TYPEOF [MERGV <br /> �i;ng ❑ELEC. <br /> ND. TVPE OF EQUIPf.7ENT"'--� � FEE <br /> • '_.t._.'_—— <br /> AIR CONO. VNIT$-M.P. EA. . .'� 5 _T <br /> NO. TVPE OF FfXiUFE OR ITEM FEE' IAtFA��1ENAT10N UN�fS� ��✓En. �_ y <br /> HA1H ii1�3ti IS OOIIERS H.v EA. """ - '- � <br /> CIOTHESY1nSNEft ' • ^��"" - - _--r— <br /> FO�CED AIR 5�'STE�.�!: O.T.U. MEA. � <br /> U�511 W:SHEH$ � � � <br /> UHINKING FOUNTAINg � �-..-'—" '—"' '�- -T <br /> S�ACE b WAIL MEaTENS �- P.T.U. _ <br /> Fl OOH D��Ait�S � =- � <br /> UNIT HEI�TEA$ N.T.V. <br /> KITCHtN ti1NKti & DISV. � --- -----�- T <br /> HAVt51NKS i EVnvONnTIVECOOLEHS ____, �_, � <br /> NUOF DRnINS RnIY IEAqERS � CLOn�ES DRVERs �� 1 <br /> SH171�'tH flATMti ' -T- <br /> VENTILATION'FnN <br /> 5[RVICE SIVKS RANGE HOOD � <br /> $UMP$ - SE\VAGF. PUMP q�H N4NDlINf.VNI7 � C.f_M. y <br /> - � " '_"�. ..._ ..--.�_�'.��� <br /> U�INALS -""-'�'-"' � 1 <br /> WAIEN CLOS[TS � _ . ""-. --.._ .- . . . _ ._..._ . .-------r— <br /> WAT_E(7 HEaTE11S �- ELECTRIC � w�TEA NEATER _ . ��_�,�� <br /> WASM BASINS ' � FAC. BUILT FIREPIACE h CHIMNE�' _r � <br /> _ _ ....�—"T_� <br /> IAUVDI7Y THAYS 6A5 SYSTEM_MO OP OUTII-.15 _� <br /> i ' "' � � � �SUfI TO(Al 5 T_ <br /> __�_'_.. vEPMIT._5 ..___.-A <br /> � -'-�- ---�" TOTALfEE 5 � <br /> $U� TOTAL � T1U.S VEPG�IT UECOMES NUI L nN0 VOtU II WUHI: 11H OUNSTfiVC <br /> PERMIi S TION AUf110RIZED IS M1OT f.U!dMINCCn W�T�11N 1'O U�v5, Oq IF <br /> TOTAL FEE � CONSTPUCiION OR WOfiK UI.U'��`FNDEO Ofl AOnNOPtiED FOfi A <br /> NATER SF.RViCE SIZF BLDG SUPPLY SIZE P�mpo oF 170 OAVS AT AN'/ nn�t nr r[NwOnK �SCMd�•1ENCEU. <br /> �d I IICH60Y CERTIFY T11A7 I IV�Vf: IiEA[> AND E`(nR1�NCD flll: nP� <br /> � S� A S flACr. NknH YANDSE TdAGK, p���pTipN AND KNOW THE 54�'C TO Ill THUF. AND COi:ltf"f.i. ALL <br /> VROVISION$ OF LAP�S ANU 0�1PINANCES GUVEftNiNG THIS TVPEi <br /> OF \YO��K W�LI BE CO.'dPUEO WI�11 WMETMFR tiMEC�FIlU HERE�NI <br /> U5E 'LUNL � lUT AIILA VACANf IIITb O� NOT, THF GRAN7ING ni A PERMIT DOES NOT PHESUME TOI <br /> GIVE AUTHOfi1TY TO VIOl1fE ON CANCtI inE NAUV4IQNS OF <br /> - ' ❑YES DNO ANv OT��Eii STATE 011 LOCAL L(1W IILCiVL/�TW(:CONtiT11UCTiON <br /> TVPEUfCONST. UCCUYANCY(iROVY NU,OFOWELUNG ORiMEPERFDHMANCEOFWNSTHVf.710N_ <br /> UNITS <br /> SIZE OF OIOG. NO.OF STORIES MA%.OCC. LO�+D R ^ • � ` � �OV �v I�1�1� <br /> ' X �a,a�'�^ 1 J <br /> S�GNATU��EOFCONTRACiD��Of�nUT11. 4(iENT DATE <br /> �I�INkZONE IIA1:kMLfJT �IFiI".I'IiINK1.C115 <br /> � HEDU111EU NL.�NC��[C� NUn1Ut�1 YLAN CMLCK 1 LL <br /> � ❑rES ❑No ' 1![ ItECE�ri Nn. <br /> n� ,� ._ ,'�. <br /> SvkC1AL CONOITIONS: ... �� % /L� '- � (i' �. . .' <br /> - ...�.�.. ..��.._ . . . ... . .. ..... <br /> FEES VALUATION � __FEE <br /> _ T� �� <br /> I <br /> _ �� <br /> ' ..���.� / ' . <br /> ----�- � oui�oiNc � x �"�_�_' _ __ _ �� t<. <br /> ..r--• <br /> �_ i <br /> SEPA REVIEW GOMPLETE � ❑YES ❑ NO ' "<<'Mn�Nn _� - j <br /> tonlacf plann�nq dOF1L MlC1UNICAI • _ . i-_ ... <br /> - • i <br /> , onrtn i <br /> --� <br /> �uC��wNe�Un�u�r. rur���nlulu�v. Nrnavlu un�a;ur.i.cl+r ppNALTY SEC.�O]1�1 � <br /> _..l__ <br /> . . � . 1 TOTAL_ _'.__...'_' ' _' "_." i <br /> ----- ------- ------- --- " �E� <br />