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ihe fvergreen � � <br /> ��r��F �;(?I��TRUCTION �verett <br /> 4 <br /> i evexett FERNiIT <br /> f11V N411 'S9SftiS <br /> L�[ftt il.1':ANIINFlf14 <br /> 9A)ll <br /> ,�°, °� �°�'�°':°, BUILDING MECHANICAL PLUMBING <br /> � Lqf111P1,'141 <br /> IOWNER MAIL ADDflC55 21P PHONE <br /> ARCIIITEC� DES�R � M1�AIL AOOawFEpS� PHONE LICENSE NO. � <br /> GENEFAI CONTRACTOR MAIL ADDRE55 PHONE LICEfJSE NO. � <br /> MECHANICAL CONTRACTOP MAII ADDfiESS PNONE LICENSE NO. <br /> � <br /> PlU1d01NG CONTRACTOR MAIL AD�RE55 PHONE LICE E NO. W <br /> JIl�1 P?.t�� 2C@ As0 D �Jc[t� � <br /> PERMIT CLASS OF WOFk Z <br /> ❑�UILDING � �'WM�ING ❑MECI�ANICAL ~ <br /> mNEW ❑AODITION ❑ALTERAiION ❑REPAIR � <br /> VqLVATION OF WORK � <br /> ❑DEMOLISIi ❑FLNCE ❑SIGN ❑SWIMISING POOI W <br /> s a <br /> DESCRI�H WORK O�Q <br /> 0 <br /> PROPOSED VSE MECHANICAL <br /> TVPEOFFUEI �OI� �G^'. �LPG. �ELEC. <br /> � LEGAL DESCFIPTION OF PROPERTY �SHOW BELOW OH ATTACH <br /> FOUR COAIESI <br /> NO. TYPE OF EdUIPMEN7 FEE <br /> LOT OLOCK—.OF q�ft COND. UNITS-H.P. EA- 3 � <br /> REFftIGEPATION UNITS-H.P. EA. —� <br /> 60I1ER5-H.P. GA. � <br /> GAS FIRED A.G. UNITS-TONNAGE EA. <br /> FOFCED AIR 51'STEMS-6.T.U. M EA. � <br /> JOB�E� Wl+LLIiEATE(35-�.T.U. M <br /> UNIT 1/EATERS-E3.T.U. M � <br /> � [VAPOFiATIVECOOLEFS <br /> PLUMBING c�onaEs oavens � <br /> VENTIIATION fAN <br /> RANGEHOO� � <br /> AI{i HANOLIN(i VNIT- C.F.M. <br /> TYPE OF FIXTUP.E OR ITEM FEE INCiNERn7oP � <br /> WATER CLOSET IT�III.ETI 5 <br /> UATHTUO � � <br /> LAVATORY �WASHBASINI <br /> SHOWBR <br /> KITCHEN SINK F OISP. SUB TOTAL 5 � <br /> DISH\VASHER PERMIT 5 <br /> LAUNDRVTRAV �OTAIFEE S I <br /> CLOTHES WASHER THIS PEPMIT 6ECOMES NULL AND VOID IF WOflK OR CONSTRVG <br /> WMER HEATER TION AUTHORI2ED IS NOT COMMENCED WITHIN 170 DAYS. OR IF <br /> UFINAL CON3TRUCTION OR WOfiK IS SUSPGNDEO OR ADANDONG� fOR A <br /> —� PERIOD OF 120 OAVS AT ANV TIME AFTER\VORK IS COMMENCED. <br /> _ DRINKING FOUNTAIN ____{ <br /> FLOOH-�S�NK OR DRAIM I NEREOV CERTIFV TNAT I NAVE HEAp AND E%AMINEO TNIS AP- <br /> VACUUM FiREAKERS —� PLICATION AN� KNOW THE Sl�M[ T�13E TRVE AN�CORRECT. ALL <br /> PFYOVISIONS OF LAWS AND OR�INANCES GOVLFNING THIS T\'PE <br /> ROOF DFAINS-fiAINLEADEflS —� OF 1N09K WILL OG COAIPLIED WITH WHEI'HEP SP@GPIE� HEREIN <br /> SINK ISERVICL-❑AR, ETC.1 ——� OR NOT, THE GRANTING OF A PERMIT UOES NOT PFLSJME TO <br /> —�— GIV[ AUTHORITV TO VIOLATE OR CANC[L THE PROVISIONS OF <br /> l�NV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> ORTNEPERFORMANCEOFCONSTFUCTION. <br /> SUDTOTAL <br /> PERMIT S <br /> TOTAL FEE $ �_ <br /> x <br /> i <br /> SIGNATUPLOf-CONT(iACTOAORAUTH.AGENT DATE <br /> SIDE ��+RC SEl"OACK STREET SETI3ACK REAF VARUSET�ACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE ftELE1PT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> ❑vEs ❑NO FEES VALUATION FEE <br /> I 1yPE OF CONST. OCCUPANCV GROVP NO.OF DWELIING � <br /> UNITS <br /> I <br /> SIZE OF �LDG. NO.OF STORIES 1+1A%.00C. LOAD UUILOING 5 I <br /> I PWMBING u7 � � <br /> FIFEZONE OASEMENT FIRESPRINKLEfiS <br /> � RC�UIFED MECHANICAI. � <br /> I ❑YES ❑NO _ <br /> I <br /> SPECIA�CONDITIONS: OTHEFl � <br /> I _ PEN[LTY SEC. a071a1 � <br /> I <br /> TO7AL uz I c�a <br /> - PERMIT VALIUATION <br /> WHENPROP[RLV VALIDATE', IIN THISSPACC Tf11515 VOUfiPERMIT <br /> APPLIL�TIONACC[PTEDBI"'. PLPNSLNCCKEDBY: PPPfl01��fORI5511NNLEBY. <br /> v� <br /> � � <br />