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CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • 6UILDING Y MECHANICAL • PLUMBING <br />141A171 <br />3y86 <br />OWNER // /. MAIL ADDHlSS ['+a ✓� P J' PHONE . <br />� S�'tyty <br />— XI", Lj Lnc 63% _Si�o, Fr �/v�l <br />ARCHITECT OR DESIUNER MAIL ADDRESS &,4, ICUUY'h- 2C PHONE LICENSE NU. <br />nn <br />%fSCP7ClUn A, le',,. ,SPJ 1154 <13oy—i,fS"C) (cwnOX 6-1`2. <br />GENERAL CONT RC I III' MAIL ADDRESS PHONE LICENSE NO. <br />/' <br />i` , CA <br />S G_Z; Pi c-S /! I-J Cr /YID <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUME'ING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />❑COMBINATION <br />❑ BUILDING ❑ PLUMBING []MECHANICAL <br />VALUATION OF WORK00 <br />S ri t� CC)i <br />CLASS OF WORK <br />❑NEW []ADDITION ❑ALTEIiA nON ❑f+LPAIFI <br />'- <br />❑DEMOLISH ❑FENCE ❑SIGN ❑':WIMMINO POOL <br />OLSCF410E7WOOR-K <br />/J >LPi/O/- - rdn <br />PROPO ED USE <br />ri�E'cir._ <br />OTHER PERMITS OR APPROVAIS <br />REZONE $( SPECIAL USE <br />#VARIANCE •ii }� SHORLINE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK—OF- <br />5 EPA CHECK LIST REQUIRED <br />]� VCS <br />1:1 NJ <br />JOB ADORLSs — <br />1 — 'T <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑OAS ❑ELEC. <br />_.- FEE <br />5 1 <br />NO. <br />_ <br />__ _ TYPE OF EQUIPMENT _ �_— <br />AlR COND. UNITS-H.P. E_A. <br />REFR IGE RATION UNIrS If.P. En. <br />—•'---•"—�— <br />OOILERS ILP. EA.----�- <br />FORCED AIR SYSTEMS 11.T.V. MEA. <br />NO. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />-- <br />— <br />_ �— <br />HAIH TABS <br />S <br />I <br />CLOTHES WASHER <br />I <br />L <br />DISH WASHERS <br />1 <br />-----------. _._._ <br />SPACE & WALL HE 4TERS - P.T.U. <br />I <br />DRINKING FOUNTAINS <br />1 <br />—•— <br />—� <br />FLOOR DRAINS <br />, <br />KITCHEN SINKS & DISP. <br />I <br />UNIT HEATERS A.T.V. <br />HAR SINKS <br />+ <br />EVAPORATIVE COOLERS <br />ROOF DRAINS RAIN LEA13ERS <br />+ <br />CLOTHES DRYERS <br />1 <br />SHOWER BATHS - <br />VENTILATION FAN <br />SERVICE SINKS <br />RANGE HOOD <br />1 <br />SUMPS - SEWAGE PUMP <br />__ <br />.. <br />_._ <br />—' " <br />AIR_ H_A NDLING_UNIT C.F.M. <br />.- _ —. _�... .__ . . ._-_.—.__ <br />WATER HEATER — <br />FAC. BUILT FIREPLACE &CHIMNEY <br />.— _. <br />OAS. SV STEM: NO OP OUTLLIS <br />can n)Tnl s <br />—T— <br />—---�•-- <br />_ 1 <br />.-• T <br />URINALS <br />I <br />I <br />- WATER CLOSETS <br />WATEIi IS -ELECTRIC <br />2_. -- <br />I <br />1 <br />--- <br />SINS <br />WASH BASINS <br />�+— <br />LAUNDRY TRAYS <br />1 <br />--••..__•_ PERMIT S <br />_ _I <br />— <br />SUR TOTAL <br />+ <br />TOTALFEE S <br />—_.r <br />I <br />_ <br />THIS PERMIT BECOMES NUI L AND VOID 11 WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMLNCED WITHIN 120 DAYS. OR IF <br />CONSTRUCTION OR WORK 10 SUSPENDED OR AOANDONEO FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COn1MENCED. <br />I IIEREOY CERTIFY THAT I IIAVE REAL) AND EXAMINIO THIS AP- <br />PLICATION AND KNOW THE SAME TO ILL• TRUE AND COI1111. CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THUS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER'IFECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHOnITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW HEOULATING CONSTIIUCtION <br />OR THE PERFORMANCE OF CONSTRUCTION. , <br />X <br />" <br />PERMIT 5 <br />_ <br />TOTAL FEE s <br />WATER SERVICE SIZE—BLDG. SUPPLY SIZE <br />G S A K <br />REAR YARD SE TO ACK- <br />'Ulf lUNt <br />LUl AHLA <br />1/ACAN�31'k <br />OYES ONO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />SIZE OF BLDG. <br />_1111- LANE <br />' <br />NO. OF STORIES <br />ILA::k ME NI <br />MAX. OCC. LOAD <br />EQ SI'RINK LLIIS <br />REQUIRED <br />REOUIREU <br />❑YES NO <br />SIGNATURE OF CONTRACTOROR AUT.H. AGENT "GATE <br />ITLAN CHECK NUMBER <br />7 .S1 / <br />FEES <br />PLAN CHLCK kEt <br />FEE RECEIPT NO. <br />% I.2'D <br />VALUATION FEE <br />SPLCIAL CONDITIONS: <br />1 <br />BUILDING <br />S la ZO V <br />SEC. OOO IY)—I— <br />4e 1 r' <br />1 <br />_ <br />I <br />1 <br />SE PA REVIEW COMPLETE ❑YES D NO <br />contact PlBnnlnq dept. <br />PLUMRINII <br />MECIIANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />AWL A71UY 1111:IT1:UYY: <br />rlww: L'MWROYY: <br />ANNUYIU OR L4UAYCIYY- <br />. C , <br />