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!PERMIT APPLICATION <br />BUILDING MECHANICAL PLUMBING <br />/�2 <br />5?3L <br />,ib X - <br />OWNER <br />MAIL AUUHLSS ZIP <br />1•HUNE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS PHONE <br />LICENSE NO. <br />GENERAL CONTRACTOR <br />MAIL ADDRESS PHONL <br />LICENSE NO. <br />MECHANICAL//CONTRACTOR <br />MAIL ADDRESS PHONE <br />LICENSE NO. <br />LLUMBING CON RgCTOR <br />MAIL ADD RESS PHONE <br />LICENSE NO. <br />• <br />CLASS OF WORK <br />NUMBER OF STORIES <br />QDUILDING ❑ PLUMBING ❑ MECHANICAL <br />BAS%iEi1T <br />PNEW ❑ADDITION, ❑ALTERATION <br />❑REPAIR <br />VALUAI ION OF WORK <br />(„]DEMOLISH []FENCE ❑SIGN ❑SWIMMING <br />POOL <br />DESCRIBE WORK <br />PROPOSE06SE <br />LEGAL DES'-P.IPT ION OF PROPERTY (SHOW BELOW OR A)'TACH <br />FOUR COPIES) <br />LOT SLOCK__OF <br />' <br />JOB ADDRESS <br />h <br />PLUMBING <br />MECHANICAL <br />TYPE OF FUEL ❑OIL ❑GAS ❑LPG' <br />PLOT PLAN <br />-Fro- OF FIXTURE OR ITEAI <br />NO' TYPE OF EOUIP.MENT <br />Draw lot lan <br />=mil- p <br />_ WATER .; CSET IT0ILETI <br />AIR COND. UNITS-H.P, EA. <br />back <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />On side. <br />LAVAiCRY (WASH BASIN) <br />ROILERS-H.I'. EA. <br />S HOIt ER <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />KITCHE'. SINK 6 DISP, <br />FORCED AIR SYSTEMS R.T.V. M EA. <br />DISNIIAE�ER <br />WALL HEATERS-R.T.U. Ai <br />LAUNORv TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOT• -ES WASHER <br />WATER HEATE' <br />EVAPOP `.TIVE COOLERS <br />URINAL <br />CLOTtIC DRYERS <br />DRINKI\" FOUNTAIN <br />I-- VENTILATION FAN <br />' <br />FLOOD -SINK OR DRAIN <br />RANGE HOOD <br />VACUC't 3REAKERS <br />AIR HANDLING UNIT- C.F.M. <br />HOOF C=AINS-RAINLEAOE'$ <br />INCINERATOR <br />SINK (SE 'VICE —BAR, ETC.) <br />T'y <br />SIDE YA130 SEidACK ST RE ET SE TUACK <br />— •. <br />REAR YARD SETUACK <br />LSIGNATUNFOI: <br />USE ZONE LOT AREA <br />VACANT SITE CUNT 'ACTD'O11 nUTH.AGENT DALE <br />❑YES []NO <br />TYPE OF CONST. OCCUPANCY GIiDUP <br />FEES <br />NO.OI' DWLLLING <br />UNITS PLAN CK I I• C) <br />VALUATION <br />SIZE OF BLOC. NO. OF STOHILS <br />MAX. OCC. LOAD ➢LDG PMT I'72 — <br />MECH PM`P <br />PLAD] CK <br />FIHE ZONE UASLM NT <br />FIHL SI•IIINK LCRS PL➢G PM'P <br />RcouuleD TOTAL <br />❑YES ❑NO <br />1 <br />