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� tAr. Ever��r��en <br /> ����oF CONSTRUCTION eve�ett <br /> �Ve���� PERI�;�Ti <br /> UIv11�IL )5923F.i <br /> [vtnrrr,r,as�ir�smr� <br /> �swi <br /> �EP� °°��MM°���� BUILDING MECHANICAL PLUMBING <br /> ocv[iaart+[rvr <br /> OWNEFi MAILAD�FESS ZIP PHONE <br /> !`.IJI�h r;.., r.*: 3 '� ",.k'.�61�. ' .°�41� �+p'�q <br /> ARCHITECTOROFSIGNER MAILADORESS PHONE LICENSENO. �V/�{� <br /> GENERALCONTRACTOfl MAILAODRE55 PHONE LICENSEf�O. <br /> �} ♦]tf i <br /> R/.jl�l. <br /> MECHANICALCONTRACTOR MAIL ADORESS PHONE LICENSE NO. <br /> � <br /> PLUMBING CONTRACTOP MAII ADDf1E5S PHONE LICENSE NO. w <br /> m <br /> � <br /> PERNIT CLASS OF WORK � ' <br /> z <br /> •U 6UILOING ❑ PLUMBING ❑MECHANICAL �p ~ <br /> ❑NEW ❑ADDITION ❑ALTERATION yrREPAIft � <br /> VALUATION OF WOFK � <br /> �� „�. I ❑DEWOLISH ❑FLNCE ❑SIGN ❑SWIfdM11WG POOL W I <br /> s :�(7I1►t14i� °' I <br /> DESCft18[4VORK ���•j <br /> 1 <br /> aaoPosEo use MECFIANICAL <br /> C1•'��-', TVPEOFFUEL �OIL �NHT. �LPG. �E�EC. <br /> LEGAL DESCflIPTION OF PftOFEflTY �EHOW EI[LOW OR ATTACH �,�5 <br /> FOUR�Q�'�sl ,y�_ .,...,-..-.np - •,�� r�. �,� NO. TY'PE OF EQUIPMEN7 FEE <br /> LOT �'�CIlOLOCY. S1W'OF � � AIR CON�. UNITS—H.P. EA. 5 � <br /> REFRIGERATION UNITS-H.P. EA. <br /> 601LERS-H.P. EA. I <br /> GAS FIFED A.C. UNITS-TONNAGE EA. <br /> FOFCED AIR SYSTEMS-B.T.U. M EA. � <br /> JOEI A�DRE55 WALL NEATEPS-�.T.U. M <br /> '}yy� i�f;f•. UNITHEl1TEF5-B.T.U. M <br /> JJn.v ��i: � <br /> EVAPORATIVECOJLEftS <br /> PLUMBING CLOTHESDRVERS I <br /> VENTILATION FAN <br /> RANGENOOD <br /> l�IR Hl�NDLING UNIT- C.F.M. � <br /> NO. TYPE OF FIXTURE OR IiEM FEE iNCINERA7oR � <br /> WATER CLOSETITOILETI 5 <br /> BATHTUU <br /> �f�VATORY (WASH BASIN) � <br /> SHOtNER <br /> KITCHEN SINK& DISP. SUB TOTAL S ! <br /> pISHWAS1iER PERMIT 5 <br /> LAUNDRY TRAY +_ TC�TAL FEE 5 I <br /> CLOTRHS WASHER THIS PERMIT BECOMES NULL ANU VOID IF WORK OFi CONSTRUG <br /> WATEF HEATEfl ,� TION AUTHOfiIZED IS NOT COMMF.NCEO WITHIN 120 DAVS, OR IF <br /> URINAL CONSTRUCTION OP WORK IS SUSPENDED OR ABANOONED POR A <br /> PflRIOD OF 120 DAVS AT ANV TIME AFTER WORK IS COMMENCE�. <br /> DRINKING FOVNTAIN <br /> FLOOR-SINK OR DRAIN I 1EFlEBV CERTIFV THAT 1 HAVE qEAD ANO E%AMINED TFIIS AP� <br /> - PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> VACUUM 6REAKERS pqOVI510N5 OF LAWS AND ORDINl1NCES GOVERNING THIS TVPE <br /> flOOF Df1AIN5-RAINLEADERS _ O� WOHK WILL BE C01dPLIEf] WITH WHETNER SPECIFIED HFREW � <br /> I SINK (SERVICE-BAF, @TC.) 09 NOT, THE GRANTING OF A PERMIT DOES NOT PFESUhiE TO <br /> G'�VE AUTHORITV TO VIOLATE UR CANCEL THE PRGVISIONS OF <br /> I AVV OTHEfl STATE Ofi LOCAL LI�W FEGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SUB TOTAL <br /> PERMIT 5 T— <br /> TOTALFEE 8 <br /> x <br /> SIGNATVREOFCONTflACTORURAUTP-AGENT Ul�TE <br /> SIDE Y�+RD SETOACK STREE�SETBnCK RE4R VARDSET6l�CK PLAN CHECK NUM6ER �PLAN CHECK FEE � <br /> FEE RECEIPT NO. <br /> UGE ZONf LOT AREA VACANT SITE <br /> ❑vE5 ❑No FEES VALUATION FEE i <br /> TVPE OF CONST. OCCUPANCY GROUP NO.OF DN'ELLING _ T— � <br /> UNITS I <br /> 512E OF BLDG. NO.OF STORIES MAX.OGC. LOAD BVILOING 5 �� � ^-` � <br /> — }-- <br /> PLUMBING � <br /> FIREZGNE BASEMENT FiFiESPflINKLERS � <br /> FLQVIRED � <br /> ❑YES ❑NO MECHANICAL I I <br /> � I <br /> SPLCIAL CONO�TIONS: OTHER I � <br /> I PENELTV SEC. �031a1 � <br /> • <br /> TOTAL <br /> PERMIT VALIDATION <br /> WHEN PROPERLV'JALIDATED UN tI�15 SPACEI THIS IS YOl1R PEFMIT <br /> I <br /> ,WPI.IC�TIUNACCEPTE00V�. PLFNSCMECNEUBY: fPPflOVEOFCRI55l1ANCEC� <br /> ewP'r CwF� <br /> �� <br /> � <br />