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`�.,�1PPLICATION FG-�t <br />�.E".,°`"° CONSTRUCTION �°°`�" <br /> itt OF <br />�verett PERMIT <br /> UILDINIi DEPARTMENT <br /> s9-87a5 TO BE COMPLETED IN INK- PLEASE PRINT <br /> i DEMOUTION ❑ COMBINATION C�1'BUILDINCi ❑ MECHANICAL ❑ PWMBING p SIGN <br /> '�ER M�IL�09f1E55 Cltt 21P PIIONE <br /> 1�a�_l , kl� /.l� 72 zo - 77�A�•�, S; E, Snolo,�;rl �,�4, S�o-�✓F�7 <br /> NiIECiONUESIONEP M�I�AOORESS Cltt ZIP PNONE <br /> sq,,,� 98 zqo <br /> vER�ICONiR�CTOR M�IL��ORESS Cltt 21P PMONE IICENSE• <br /> SR�`1C <br /> N�NiCAI CONiR�CTOq M�IL AOORE55 GTV IIP PIIONE tICENSE• <br /> \' <br /> MBINOCONiR�GIOR M�ILRODRE9S CITY ZIP PI�ONE IICENSE• <br /> 1 � <br /> i5 OF�Y.'ORK <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIp ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIIDING REIOCATION <br /> A1IONOFWORNI T04M�TENULSPLUSU �RI <br /> �_�� 7�, vvz� <br /> CRiBE WORN T � � <br /> Cons 7�r„ c. �we /�,'ri i �a�'a Dr'�ve.w,. <br /> OF BUILDINO <br /> S; n • I HEREBY CE TIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> 4 � F��. PLICATIONANDKNOWTHESAMETOBETRUEANOCORRECT.AIL <br /> '�LDESCRiP110NOF FENiY�SHOWNBEL OR�TT�CHF/OURCOPIES� pqOVISIONSOFLAWSANDOFDINANCESGOVERNINGTHISTYPE <br /> � C I'C s o�d OF 4YORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HERE- <br /> eiocK_or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> / GIVE AUTHORITY TO VIn�.ATE OR CANCEL THE PROVISIONS OF <br /> � p To L'V i� ANYOTHERSTATEORLUCALLAWREGULATINGCONSTRUCTiON <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> S���L. � 3 � � h C'� ` �/ SIGNATUPE OF CONTRACTOR OR AUTNOR12ED r1GENT DnTE <br /> X � [✓�� .Se�/. � (�c4��� <br /> ECt�ODRE55 '� f�/� APPIIC�NiSCITYBU51NE55LICEN5EN0. T, <br /> fi �� � � <br /> . . <br /> MBIN4 MECHANICAL <br /> ). TYPE OF FI%TURE FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOIIEn AIR COND.UNITS—H.P,EA <br /> ` BATMTUB REFRIGERAiION UNITS—H.P.EA. <br /> LAVATORVIWASH BRSINI / BOILERS—H.P.EA. <br /> SHOWER GAS FIRED AC.UNITS—TONNAGE EA <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA <br /> OISHWASHER WALI HEATERS—B.T.U. M <br /> LAUNORY TRAY UNIT HEATERS—B.T,U. M <br /> CLOTHES WnSHER EVAPORATIVECOOLERS <br /> CLOTHES ORYERS <br /> URINAL .� VENTILATION FAN 3 S� <br /> DR�NKING FOUNTAIN I RANGE HOOD ,5� � <br /> FIOOR DRAIN AIR HANOLMG UNIT— GF.M. <br /> VACUUM BREAKEFS STOVE <br /> ROOF DRAINS—RAINLEADEFS O � METAL FIRcPIACE 8 CNIMNEY <br /> SINK�SERVICE—UAR,E7C. �'�'OO�STOVE/FIR PLACE INSERT <br /> �� <br /> SUB TOTAL SUB TOTAL S <br /> PERMIT S PERMIT S <br /> TOTALFEE 3 TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> SLfO�CN qE�RSEIOACK SIOESETBACK PI�NCNEGKNUMBER PLnNC11ECRFEE � <br /> �� �� � � � �� / ��' /� FEE ���SS NECEIPINO.CIG/ �] <br /> vE LOT�RE� � W 0 O 10 �t <br /> V ANi SItE FEES V�LUIITION FEE <br /> ��I �YES ONO - <br /> ''CONST. OCCUP�lNCYGROUP NOOFOWELLINOUNITS <br /> OL00 /� NO.�S ORIES MA%10CGLOAO BUILDING S �JrO��� s�� <br /> � F ('1�•z 1/J� - ' 'r PLUMOING �s <br /> i <br /> MECHANICAL � <br /> iPRINKLERS REOUIRED ❑VES ❑ NO � � J <br /> OTIiER p <br /> PENALTY . �[� <br /> ��IIONACC �v FUNSCIIEGNEDOY APAR.fOR155U�NCEBY -- <br /> V�-�` � J��/S � �c TOTAL � �v �v <br />