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Ihr Evel;greP�r <br /> ���� .�F �ONSTRU�TION ev�rect <br /> ever�Jtt PERMIT <br /> LItY u.qll 1596:iG <br /> EVEFiii,lYqp�qINGiON <br /> 331J1 <br /> °"' °"°""°'."` BU!LDING MECHANICAL PLUMBING <br /> [Iq'F�:IC^ENI <br /> OLYN[R MAILryA�O�WDftESS ZIP PHOnNE <br /> . .n...-....i r'.i Fi't�_ C:iG� 1 tr�r.:.:.�F JT.w��-?� �V'�)ti <br /> ARCHITECT OR DESIGNEF A1AIL N�OFE55 PHONE LICENSE NO. <br /> GENEFALCONTRACTOR MAILADDRE55 PHONE LICENSENO. <br /> ��� <br /> MECHANICALCONTRACTOR MAIL ADORESS PHONE LICENSE NO. <br /> PI.UMUING CONTpACTOR MAIL A�DRESS PMONE LICENSE NO. � <br /> W <br /> m <br /> PERMIT C1A55 OF WORK � <br /> � <br /> y�' z <br /> �]BUI�DING � PLUMpING �MECHANICAL �q � <br /> �+jNEW ❑l1DDITION ❑ALTERATIOfJ ❑REPAIH � <br /> VALUATION OF WOflK <br /> 5 y,���� ❑�EMOLISH ❑FENCE ❑SIGN r]SWIMMING POOL W <br /> DESCHI6[WORK a <br /> c.- , .. <' �n:'. . - 1616 <br /> YROPOStO US[ <br /> MECHANICAL <br /> TVPEO� FUEL �O!L �NAL �LPG. �ELEC. <br /> LLGAL nL`3CHIPTION OF PFOPERI v ISHOW pELOW OR ATTACII GHS <br /> FOUql.C�lOPi"5) 9� <br /> �oT��i[��ocK�oF �'-?�� � �� � � N�� TYPE OF EOUIPMENT FEE <br /> AIF COND. UNITS-H.P. El�. 5 I <br /> RE�RIGERnTION UNITS-H.P. lA. <br /> �OILERS-H.P. LA. � <br /> GAS FIRED A.C. UNITS-TONNAGE EA. <br /> FORCED AIR SVSTEMS-U.T.I' M Eq. � <br /> JO'.i ADDRESS I�}�� p WqLL HEATERS-�.T.U. M <br /> ��j�G� ��t' �'.:_�;i{ <br /> UNIT MEI�TLRS--�.7.U. M I <br /> EVAPORATNECOO�[PS <br /> PLUMBING CLOTH[SDFYERS � <br /> VENTILATION FAN <br /> I flANGEHOOO � <br /> i NO. TVPE OF FIXTURE OR I7EM FEE — /�Ifl HANDLING UNIT- C.F.M. <br /> WATER CLOSET(TOII.ET) 5 INCINERATOf+ � <br /> BATliTUB <br /> �AVATORV (WASHBASIM � <br /> SHOWER <br /> KITCHEN SINK & DISP. SUP TOTAL 5 I <br /> 01511WASIiLR � <br /> - PERMIT 5 <br /> LAVNDRY TFAY <br /> CLOTHES WASHER TOTAL FEE 5 � <br /> WATER HEATER 1HIS PERMIT �ECOMES NULL AND VOID IF LYORK OR CONSTRUC- <br /> — TION AIrTHOHIZEO IS NOT COMMENCED WITHIN 120 DAYS, OR IP <br /> Uf11NAL CONSTRUCTION OR WORK IS SUSPENOED OR AE3ANOONE� POR A <br /> ORINKING FOUNTAIN PERIOD OF 120 OAVS AT ANY TIME APl'ER WOFIK IS COMMENCED. <br /> PLOOfl-SINK OR OFlAIN I HEREUv CERTIFY THAT I HAVE flEAD l�ND E%AMINLO THIS AP- <br /> VACUUM 9REAKEPS PLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT. ALL <br /> NOOF DRAINS-RAINLEADERS P�OVISIONS 9F I_AWS ANO ORDINANCES GOVEqNING THIS TYPE <br /> OF WOFlK WILL 6E COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> SINK (SCRVICE-pAR, ETC.1 OR NOT, THE GRAf�TING OF A PERMI'i DOES NOT PqESUME TO <br /> GIVL AUTHOiITV TO VIOLATE OR CANCEL TMB PROVISIONS OF I <br /> 11NV OTHER STATE OR �OCAL Ln1N FEGULl�TING CONSTRUCTION <br /> �_�.— OR T4E PERFORMANCE OF CONSTRUCTION. <br /> SUe TOTAL <br /> PERMIT 5 <br /> TOTALFEE 5 —' <br /> i x � (, <br /> : SIGNATUREOFCONTRACTOROFAUTH.AGENT DATE <br /> SIDEVAqO5FT9ACK STHLETSETEIACK REPRVAfiD5ET0ACKPLl�NCHECKNUMRGfl PLANCHECKFEE <br /> 'nt; FEE �y,� qECE�IP�Tr NO <br /> iUSE 20NE LOT A!iEA VACANT SITE ���^�� ui�� Jil'-�G <br /> ❑YES ❑No FEES VALUATION FEE <br /> I TVP[ OF [UNST. OCCUPANCY GROUP NO.OF DWELLING I <br /> UNITS � <br /> I <br /> Si2E OF �3LDG. NO.OF STOfiIE$ MA%.00C. IOAD liUILDING 5 �.'j� Ll1iM <br /> I 4W w <br /> I - _ PWMBING I <br /> FIREZONE BASEMENI FIRESPPINKLERS _ � <br /> RC�UIRE� <br /> ❑VES ❑NO tdECHANICAL � <br /> SPECIAL CONOITIONS: OTNEfi � <br /> I <br /> - PENELTY SEC. 7031n) I I <br /> TO7A L f���� <br /> iJV <br /> . PEF.MI7 VALIDATION <br /> —' WHEN PROPERLY VAL�OAT[D (IN THISSPACE) THIS IS VOI.iR P[RMIT <br /> cl'PI.1,lIONqCCEPTEDflY: PLANtiOICf.FC�lrv. pVpqOVE0F0AI55Ol�Y.CCPt. <br /> � .'}. 4� <br /> 1__ p I <br />