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- CONSTRUCTI�N _ , <br /> PER�vIIT A�°PI lCATI�N '��� ,��- <br /> COMBINATION • BUILDtNG • MECFlANICAL o PLUMBING <br /> OV�'NEH . ;� )!i .' MAILAUUHESS � ZIY PHUN! <br /> . � i: / / <br /> i <br /> �� �"� ��: ili6��i �Y3/ c��,,�G«•c( � ,;75 7 - >'�c -� <br /> ARCM� UH UESIC:7�EH � MAIL qO�RESS PMONE UCENSE NU <br /> GENGRALCONT ACTO MAILADDHE55 PHONE UCENtiENU. <br /> � J <br /> / /, 1 <br /> Y 2/t`%' ' , � ,C.(.C-i' ��LfJ . �����r _,C,'t':LQ�fC���v���fi .)Sl�� ��� � ��G)'C�l/f-G' -/!C-�/�,�'c�i f%i <br /> MECHANICAL CUNTRAGTOR MAIL AODR SS � PHONE 11C NSE NO. <br /> PLVMfi1ryG CONTRACTOR MAIL ADDFE55 PHONE LICENtiE NO. ' <br /> YEFMIT CLASSOF WORK • ----- " <br /> ❑COMBINATION � <br /> [�OUILCING � VLVMOING �MECMANICAL <br /> �___ ❑NEW �l1DDITION ❑ALTEf1AfIUN ❑I�CI�n�{� <br /> VALUATIUNOFWpRK '- —'- - '-"-"----'"- <br /> 5 ❑DEMOLISH ❑FENCE ❑SIGN ❑SIYI�dMIN(; f•001. <br /> DESCNIOL Y:ORK <br /> f � � � <br /> „ ,( X 1 (.�S ;_ !'Tl L.l�' ����!�, <br /> �FOPOSED USE OTHER PEP,MITS OR APpROVAlS <br /> IEGAL OFSCRIPTIUN OF V{iOPERTY ISHOW BFLOW UH AtTACM � RE ZON E � SPECIA� USE <br /> FOUflCOPIESI � � Zf� #VAR!ANCE � SHORLINE <br /> LOT BLOCK_OF� � <br /> , � / � y SEPA CHECK LIST REQUIRED <br /> f7`r��i r�.I �JfJt� Ci UG� �o �C'Q�"e 7�j ]�' Y E S <br /> � NO ' <br /> JOO ADDRESS <br /> I�.�I .�7�� ^��`� �MECHANICAL <br /> PLUfNBING TYVE OF LNEHGY <br /> __ LIr.nS ❑F�F.C. <br /> . NO. TYPE OF [QUIPMEN7 � GEE <br /> __ '.'_____ ...__. ....__.._ .._'__.___ <br /> _ AIRCON0. UNITS-�Iv, EA. t5 1 <br /> . ..___�-._ <br /> NO. TVPE OF FIXTURE OR ITEM FEE RE�RIGERATION VNit; N�' Gn. -�-T ' <br /> ___'__ '.. <br /> ItAIH Il)liti 5 '__ '_'.... ______'_ '_ "_"_'"___"_"�-�__ '1_ <br /> f701�Efl5 HP EA. � <br /> � ClOi11F5 LY4SHF:H Z.�'-' - �FURCED AIR ^aYSTEMS ❑.T.U. MEA. --^"T- <br /> UISII YJASHEHS i - '_'_"'_. __"' "___" '� _L"__ <br /> UHINh:ING FOUfJI'AIN$ i I <br /> FI OOH Uf1AI�J� i � SPACE & WALL NEATERS H.i.U. T-- <br /> KITl:11FN :i1NK5 & DISP. � -' �1NIT 11EnTERS 13.T.V. �.-_ 1 <br /> ilA1; tiINKS EVnPONnI'rvE CUOI.ENS T- <br /> � —�"' l <br /> HOOF DRAINS RAIN LEADEfi: � I CLOTULSORVEPS--"'----"-' I �-T <br /> SH�)R'Eq lSATHS � VENTILATION FAN -���1.�� <br /> S[HVICE SINKS qqNGE HO00 -I I <br /> -_'-_ <br /> SUiAPS - tiEWAGE PUMP -"------_.__""' __'___�__T_ <br /> �- �-- MH HANpLING VNIT C.�.M. <br /> U111NAL5 i '_"_"_'.____'___.... <br /> ...... _._ "..._...�'__'__"' L <br /> Wl�1FR CIOSGTS 1 . . . . . . ."'._. ....... ._ . _ __.__.1..... ..__ ._._,�_ <br /> " '-"--- " --'---'-' WnTER 11F.AiCR � <br /> _ WATE11 HFATEHti - ELECIHIC � ..._ _. . _. . . ___._.._.._. . .._ .. ._ "'1.___ <br /> Wl15H BASIN - � FAQ UVILT FIH[PL�1C[ K CIII�dNEY i � <br /> _- _... _.. .. " . ___". "_" ' '_... .. " ____'" . '_ '" __'_'_�"_� <br /> LAUNDRV TffAVS , . _ GAS. SVSTEM' NO OV pV TLf.1S � _�__ <br /> — i . ___ '._._. . . .SUU TO�AI 5 ��._. <br /> _ t _ ____".. ..__-PERMIf 5 'l �- <br /> — r '__ '_'_'__'_ '� __._."_'."_"'."'__ _ _- 1_ <br /> ..""' <br /> ____. . _ . <br /> SU6TOTAL - TOTnt FEE 5 �� - <br /> 1� ' .' ' _ ' _ _' ' __'_"_. __ "' '__' '__ <br /> PERMIT y ._� 1111: YEI�MIT IIECOMES NUI l ANp VOIO 11 YVU11✓, pN f.UPi;THI:C <br /> TOTAL FEE T�nN AV�11pRIZED IS NOT (:O?.nMINC[D WITHiN I?0 L`AY::. Oq iF <br /> CUNSTIiUCi1pN 011 1YOf1K I!; $U:tPf:NDEO Oil /�pI�IJDOV[O F(1F A <br /> W/1TIiR SERVICE $IZF. �LnG. SUPPLV !iIZE YC(1100 OF f70 DAYS AT ANY fIM6 nFiCR�VOfiK L':CnN61ENCEU. <br /> � � •'� � ,.� tlACK NhAHVARpSEiH�ACY.,� � ��E.Hl�.IIV CERTIFY }-NM I IIhV[ HLAb ANDF.4AA�iNED I1115 A� <br /> PLICATION ANU KNpY! THE ::4A1E Tp Uh TfiVE %•NU rp1;RCCT. n:Ll <br /> Pf10Vl!:ION`i OF 1 AW$ ANU OIIDINAYCF:S OUYERSWG 111!5 T\'PE� <br /> OF WUIIK WILL OE CO'dPUEp Y11111 K'�1kTH[I15PECIF�'D �+EltE�N'� <br /> USL LUNh lUT AHLA�-�� VACANi :iIT! -�-� OR fJUT, THE f.RANTING f}p n PEqMIt' pp($ NJT PFEiUME "O:, <br /> � �iIVE AUTHORIT� TO VIOL4fE OH CANCIL fHE :'qUV15�ONS Of <br /> ' ❑YL'i ❑NO �, ANY pTH@R STATE Oii LOCAI LAW IICGUL4TWti CON::TIIUCTIL`NI <br /> TVYE OF CONST. OCCUMANCY(iHOUP NO.OF OWELLING ��� T��� P�fiFOHMANCE Of CONSiHUC��QN. <br /> UNITS + <br /> SIZ[ OF {�LUG. NO. OF STOqILS MA%.OCC LOAD //)f� � ) ,J1 '7��! � <br /> x ' C�"�' `I <br /> / /'�.�L�`� � � .� /��' ����'-1 <br /> L <br /> 1 IIiE T(iNt'"--� II/1:tlMlNT 1INL.51'NINKL! H.5� SIGNATUHC OF CUkTRACTORpR AUTII.AGENT n ![1 <br /> HEUUIREU FL.:NCH6C6NUM13fH VLANCIILI'I: PhL <br /> ❑VF.`• ❑NO <br /> f Ll" � RECEiPt Nf� <br /> 'SPtC1AL CONDITIONSr � ' ��L" <br /> .��.._�.� � ��� �f (i�? � . <br /> FEES VALUAI'ION I FEE <br /> _ __.____ , _._...r.__' <br /> --__'_'_...___�_�'_�.— ._ '_ � <br /> . _.._'____ .r.____ ___�' <br /> -'-'-'-'- - OUILDING S � . I� � <br /> 1- <br /> . ."" " _ .. _.�_ �_ _'_-'_...__�.._'" " '_'..."'t."" ' ''. <br /> � F\A/ /"f' O —� PLUMIIING i` I _.. � <br /> SEPA RElI... „�M. LETE � ❑YES CI NO _ � � i � <br /> —._...._.. <br /> contacl p�anninq dCP�. MCCIIANICAI • � i--- <br /> -- i.._ � <br /> OTHEq � <br /> I <br /> _ _�__ ___.T_—r <br /> �'�l1UfIUH�[�(YIIpYP Y�ryS(NIIFIUtlY .V}NUVIO--TJM4A1�'.(.IYY P('��(�LT'V $E'.T. �O7IOI � I <br /> � . I __ _.__"_ � " '... .._.__ . ___ _.-.._" ._..L.___ } <br /> � f'� I70TAL /��� j � <br /> _ . _ . ..._ _ __— .__ . .. . _.____ ._._.___'..___.. 1��_._� . � _��.el.,�.,._.: <br />