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��rYOF CONSTRUCTiUN e��erett <br /> e�eret� PERMiT <br /> cnv NqLL 159esiE <br /> tvca[rr,c:asni�,rmi <br /> seloi <br /> °E�' °F°°^�^,°�"� BUILDING MECHANICAL PLUMBING <br /> oEVE�ovrnexr <br /> OWNER MAIL nppFE55 ZIP PHONE <br /> C'•`Fj�jj.. .S`.?:' `ri� �� 't' ,^..rf <br /> ARCHITECT OR DESIGNER MAIL ADDflE55 PNONE IICENSE NO. <br /> ( GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br /> i �« .U�s J..�� r n:,:�:OT". !•�• <br /> ..• <br /> MECHANICAL CONTRACTO(i MAIL ADOFESS PHOIVE LICENSE NO. <br /> � <br /> P�UMBINGCONTRACTOR MAILADORESS PIIONE LICENSENO. UJ <br /> m ' <br /> � � <br /> I PERMIT l:LASSOFWORK � <br /> �6UILDING � PLUMBING �MECHANICAL F <br /> ❑NEW ❑AODITION ❑ALTERATION �REPAIF � <br /> VALUATION OF WORK � <br /> ��� ❑DEMOLISN ❑FENCE G�IGN ❑SJJIA"MING POOL W <br /> 5 _a <br /> DESCRIBE WORK �(�7� <br /> . �`.�:';,�:"' �n......�,P) L� t <br /> PPOPOSED USE MECHANICAL <br /> TYPdOPFUEI. �UIL �NAT. �LPG. �ELEC. <br /> LEGAL OESCRIPTION OF PROPEFiT'� ISFIOW 6ELOW OR ATTACH C'AS <br /> FOUR CO,e{ESI N�.y7 - .? `'..�: � <br /> LOT �4J OLOCK ~i��OF NO. TYPE OF E�UIPMENT FEE <br /> AIR COND. UNITS-H.P. EA. 5 � <br /> REFRIGERATION UNIT;-H.P. EA. <br /> BOILERS-H.P. EA. I <br /> Gl15 FIRED A.C. UNITS-TONNAGE EA. <br /> FORCED Alft SYSTEMS-B.T.U. M EA. I <br /> JOB ADDFESS •�f,n! - WALL HEATERS-B.T.U. M <br /> .1�...J '.: I <br /> i � ��� � � UNITHEATERS-B.T.U. M � <br /> EVAPORATIVECOOLfRS <br /> PLUMBING CIOTHES DflVERS I <br /> IVENTILATION FAN <br /> � RANGEHOOD <br /> I <br /> AIR HANDLING UNIT- 0.P.M. <br /> NO. TYP::OFFU'li'i;i�ORITEM FEE INCINERATOR I � <br /> WATER CLOSET(l O�i I`1 � 5 <br /> AATHTUP �- <br /> LAVATORV (IVASH BASIN) � <br /> SF.OWER <br /> KITCHENSINK& DISP. SU6TOTAL $ _ � <br />� DISHWA.SHER PERMIT 5 <br /> I.AUNDAY TFAY TOTAI PEE 5 I <br /> GLOTHES WASHER TIiIS PERMIT BECOMES NULL AND VOID IF WORf: OR CONSTFUC- <br /> WATER HEATER TION AUTHOFIZED IS NOT COMMENCED WITHIN 120 �AVS, OP IF <br /> URINAL CONSTRUCTION OR WOPK IS E'JSPENDED OR ABANOONED FOR A <br /> �RINKING FOUNTAIN PERIOD OF 720 OAVS AT ANV TIME AFTER WORK IS COMMENCE�. <br /> F LOOF-SINK OR DRAIN I HERE6V CEftTIFV THAT I IIAVE READ ANO EXAMINED THIS l�P� <br /> — PLICATION AND KNGW THE SAME TO BE TRVE AND CORftECT. ALL <br /> VACUUM �REAKEFS — PqOVISIONS Of- LAWS AND OROINANCE� GOVEFMNG THIS TVPL <br /> POOF DRAINS-RAINLEADEFS OF WORK WILL BE COh7PLIEO WITM WHETHER SPECIPIED HEREIN <br /> SINK (SEP.VICE-OAR, ETC.1 Oi9 NOT, THE GRqNTING OF N PERMIT DOES NOT PRESUME TO <br /> GIVE AUT40RITY TO VIOLATE OR C�NCEL THE PROVISIONS OF <br /> ANV OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br /> ON THE PERFORMANCE OF CONSTRUCTION. <br /> SUB TOTAL <br /> IPEFMIT 5 �— � <br /> iTOTAL FEE _ 5 x 7,�If�/t�. <br /> � , <br /> � SIGNATUREOFCONTRAGTORORAUTH.AGENT DATE <br /> SIDE Vl�FD SETBACK STREET SETBACK FiEAR VAflDSETBACK P[_AN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> I USE ZONE LOT AREA VACANT SITE <br /> � ❑vEs ❑NO FEES VALUATION FEE <br /> II TVPE OF COfVST. OCCUPANCV GROUP NO.OF DWELLING <br /> UNITS � <br /> II SIZE OF OLDG. NO. OF STORIES MA%. OCG LOAD BUIL�ING 5 ��',p) � ,r''".w,1 <br /> PlUM61NG � <br /> FIFEZONE BASEMENT FIRESPqINKLERS � <br /> RC(lUlq'.� � <br /> ❑YES ❑NO MECHANICAL I <br /> II $PECIALCON�ITIONS' OTHER I <br /> I <br /> I ._ PENELT�' SEC. 703(al � <br /> I <br /> TOTAL �I �.�A <br /> PERMIT VALIDATION <br /> WFIEN PHOPERLV VALIOATED IIN THIS S�'ACEI THIS IS YOUR PERA9IT <br /> I <br /> i <br /> � <br /> I <br /> � qP1�lIGV�ONACL[PT[D11Y'. PL���SCHFCREDOY'. AVPIIOVi�PoFLSVAM1f.[oY <br /> 'I 3. c. <br /> I o <br />