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CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL <br />• PLUMBING <br />OWNER MAILAUUHLSS [1P PHUNL <br />vQ <br />A CHI ECT V%R DESI(iNEH MAIL ADDRESS <br />/HOICENSt NO <br />GENERAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NU. <br />(�/%�-5// .z/ 5 /d. in�trl <br />3 � 070. <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. - <br />PERMIT <br />CLASS OF WORK <br />❑COMBINATION <br />'BUILDING ❑PLUMBING QMECHANICAL <br />❑NEW <br />[]ADDITION ❑ALTERAFIUN $HEI'AIR <br />VALU V11614 OF WORK <br />--------"'--"-- <br />/'S �—D 7,- <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑AVIMM1NT: POOL <br />ESCRJIOE WORK <br />- <br />O /• <br />PROPOSED USE <br />OTHER PERMITS OR APPROVAIS <br />REZONE SPECIAL USE <br />LEGAL UFSCRIPTIONOF PROPERTY <br />(SHOW BELOW OR ATTACH <br />FOUR COPIEsI ��s J, <br />CDr elocK of/ <br />yARIANCE SF!ORLINE <br />SE PA CHECK LIST REQUIRED <br />= YES <br />_3 NO <br />Joe ADDRESS <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑R AS ❑E LCC. <br />—__ _ TYPE OF EQUIPMENT — —T_ _ FEE <br />L_NO. <br />AIR COND. UNITS-H.P. EA. <br />51 FRIGERATION UNITS 11 P. LA. —�— <br />OOIEERS ILP. EA.------_-- -- 1 <br />FORCED AIR SYSTEMS 0_T.U_ MEA. L <br />SPACE & WALL HEATERS H.T.U. <br />NO. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />�— <br />HAIH TULIS <br />S <br />CLOTHES WASHER <br />DISH WASHERS - <br />I <br />URINKING FOUNTAINS <br />FLOOR DRAINS <br />1 <br />KITCHEN SINKS III OISP. <br />I <br />UNIT HEATERS N.T.V. _ 1 <br />-- T <br />EVnP_OHATIVE C_00_L_E HS <br />CLOTHES DRYERS <br />IIAh SINKS <br />1 <br />ROOF DRAINS RAIN LEADERS <br />I <br />SHOI'.'ER PATHS <br />VENTILATION FAN <br />SERVICE SINKS <br />— 1 <br />RANGE N000 I I <br />SUMPS - SEWAGE PUMP <br />_ <br />URINALS 1 <br />AIR 11n NDLINC. UNIT C.F.M. <br />WATEH CLOSETS <br />-- -_- -_- <br />- <br />HE ATE IIS - ELECTRIC 1 <br />WATER NEATER T <br />-T���--- <br />_WATER <br />WASH BASINS - 1 <br />FA C. BL'llT FIREPLACE (4 CHIMNEY <br />LAUNDRY TRAYS <br />�- GAS SYSTEM: NO OP OV TLL 15—• T <br />S <br />I__._- <br />... .. ._. .i <br />rUR TOrAL S I <br />I <br />- <br />PERMIT <br />--- - <br />SUB TOTAL <br />TOTAL FEE s 1 <br />PERMIT 5 <br />T1115 PERMIT UECOMES NO[ 1. AND V0111 1i W(U1K OR CONSTRUC <br />TION AU rI1OnIZED IS NOT CO`dME NICE WITHIN 1?0 DA VS, OR IF <br />TOTAL FEE <br />CONSTnLICTION OR WORK IN SUtp'r NDED Oil ABANDONED FOR A <br />NATER SERVICE SIZE SUPPLY SIZE <br />PERIOD OF 120 DAYS AT ANY (IMF AF TER WORK C: COMMENCED <br />MUI YARDL 1 S JT�L'A HkAR YARD St TBACKI <br />1 1:ERL11Y CERTIFY THAT I IIAVE RLAO AND E[AKI1,N T1115 AP <br />PLICATION AND KNOW TIIE SAME TO lib TRUE ANp COn1IE'C. f. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GUVE4NING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER :,PE.CIFIED HEnEIN <br />USL ZUNk LU7 A/ILA VACANT SITIz <br />OR NOT. TIIE GRANTING OF A PEnmir DOE$ NOT PRESUME TO <br />❑YES ❑NO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE On LOCAL LAW RLGULATINO CONSTIIVCTION <br />TYPE OF CO NST. OCCUPANCY GROUP NU. OF DWELLING <br />UNITS <br />OF; THE PERFORMANCE OF CONSTRUCTION. <br />a <br />SIZE OF DLDG. NO, OF STORIES MAX. OCC. LOADX. <br />i <br />f Illl Y['1Nk IIA::L MLNT r IN! SVIIIiNKLARS <br />SGNATUREOFCONTRACTOn ORAUTII.AGENT DATE <br />' REOUIHLII <br />❑YE.. ONO <br />PLAN CHECK NUMIOL14 PLAN LIILCK 1 tL <br />ILC RECEIPT Nn. <br />SPECIAL CONDITIONS: <br />FEES VALUATION FEE <br />�1--�•- <br />BUILDING $ <br />• <br />SE PA REVIEW COMPLETE � OYES ❑ NO <br />PLIIMRINR <br />PIOnnIn de t. <br />COn1OC1 9 p <br />--••_ I <br />MLCIIn ANICAL NICAL 1 <br />. <br />OTHCR 1 <br />I <br />V+uu IIwl Aa�IruuaT .uwLnlu lu Fr AN11ov18 wuulaKl a, <br />PENALTY SEC. 3071F1 <br />�` <br />1 <br />-_-__•_ <br />TOTAL j <br />