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CITY OI 1J l/lWJ ! :\U'•.� I Ill:\i <br />cv(111'Cct I'i�f�IVil B' <br />city fl-n 1•.1111% <br />[v1111I, nr..Y.14r <br />I'M <br />LNL fit I(Y•r AIIr <br />Li JII'lvlNt BUILDING MLCI IANICAL <br />u <br />PLUFAMING <br />UvUl C it <br />IJVJN 1. 11 MAIL. AUNNLGU Z11 I'nUNL <br />7ZtKa <br />'1'l <br />-- <br />AIICI111 LCT UA OC.".1(iNEn MAIL AUUIIISS l•JNC LICLNSii tt U. <br />� 4 <br />('d.NLAAL CU:.IRACIOn MAIL AUUIILSS PHONE LICLNSI: NO. <br />LILCIIANICAL CONTRACTOR MAIL AUDlIL55 Iy1011E LICLN5E NO. <br />5/ <br />j1 /0 <br />Ft <br />PLUMBING COUIRACTOR MAILADDRESS PIIDNE LICENSE NO. <br />1 <br />Ul <br />til <br />PERMIT <br />❑BUILDING [I':....MWNG ❑SIECIIANICAL1--- <br />CLASS or WORK <br />0tl@Tf ❑ADDITION ❑ALTERATION A]111 EPA11% <br />') <br />- <br />VALUAI-I011 OF WORK. <br />❑OCMOLISR ❑FENCE ❑SIGN ❑SWIMMIIIG POOL <br />R- <br />DI <br />DESCHIOE WORK <br />PROPOSE Us- If <br />MECHANICAL <br />TYPHOFFUEL ODIC. ❑NAT. ❑LPG. ❑ELCC. <br />GAS <br />LEGAL ❑ESCMPTION' E PUOPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES L zs <br />LOT�OELOCY - OF __ <br />D/% _e-'l ///J�/1 <br />t"/ ��"'-�'�L! n+ t�%� <br />NO. <br />'TYPE OF EOUIF'IdCtJT <br />FEE <br />AIR COND. UNITS-II.P. CA. <br />S"EFnI <br />UNITS-H.P. LA. <br />601LEIC7'$ali.P1ONA <br />' <br />GAS FIRED A.C. UNITS -TONNAGE CA. <br />FORCFO AIR SYSTEMS-R.T.U. M LA. <br />I <br />JOB AODRESS • <br />WALL HEATERS-O.T.U. M <br />{ <br />UNIT HEATERS-B.T.U. hi <br />1 <br />EVAPORATIVE COOLERS <br />--I <br />p <br />PLUMBING - <br />CLOTHES DnYCRS <br />1 <br />"-'- <br />VENTILATION FAN <br />_ <br />RANGE HOOD 1 <br />AIR HANDLING UNIT- O.F.M. <br />NU. <br />TYPE OF FIXTURE OR ITITEM_ <br />FEE <br />- <br />111CINERATOR <br />WATER CLC`+ET (TO(LflTI <br />5 -T--__ <br />NATNTU's <br />LAVAIDhY tWASH BASINI-- <br />SIIOIVER <br />I <br />KITCHE%fl\KF DICP. <br />_ <br />SUBTOTAL S <br />I <br />Si•ER <br />1 <br />- PERMIT 5�— <br />_-_OI:.H`.\'A <br />LAUNDRY '.PAY <br />1 <br />TOTALFEC S <br />I <br />CLOTHES::ASHER <br />T <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUE <br />TION AUTHOnIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COmmia NEED. <br />I HEREBY CEPTIFY THAT 1 IIAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOWTHE SAIAL TO BE TIIUC AND CORRECT. ALI. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF VJORK WILL BE COMPLIED WITH WHETHEn SPECIFIED HEREIN.' <br />OR NOT. THE GRANTING OV A PERMIT DOES NOT Pn ESU`iE TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL TIIE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL. LAW REGULATING CONSTRUCTION <br />OR TIIE PERFORMANCE OF C(TNSTnUCTION. <br />. <br />.,'7L <br />SIENATUR OFCOHACTON OR AUTH. AGEN1' DATE <br />WATER NEATER <br />_ <br />URINAL <br />I <br />-- <br />DIIINKI`:5 FOUNTAIN <br />FLOOR-S:'e'. OR OHAIN <br />1 <br />VACUUMgEAKCAS <br />{ <br />_ <br />ROOF GR A'r:5-f3AINLEADE R$ <br />{ <br />-I <br />_ <br />SINK MEAOCE-BAR, ETC.) <br />SUB TOTAL <br />--{ <br />PERMIT <br />' <br />S <br />TOTAL FEE <br />S <br />CITY <br />USS BELOW THISNT LINE <br />SIUE YARD SET_'ACK <br />STREET SLTBACK <br />BEAR YARD SETBACK <br />PLAN CHECK NUMOEn <br />PLAN CHECK FEE <br />FEC RECEIPT NO. <br />' <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUMION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO.OF DWELLING <br />UNITS <br />_ <br />1 <br />BUILDING <br />S <br />I <br />SI2.L 01: BLDG. <br />NU. OF $T ONILS <br />MAX. OCC. LOAD <br />PLUMBING <br />1--- <br />1 <br />FIIiE ZONL <br />UASG MENT <br />nrouiI•n INK LGiIs <br />n[ <br />L1YES IYCS ONO <br />MECIIAHICAL <br />SI•LCIAt. CON(1n IONS: <br />OTIICn <br />1 <br />PENELTY <br />ST C. 00](a) <br />_ -- <br />TOTAL <br />I- <br />PrAfdllVALIDATION <br />WIILN Pf1Ul'L IIL V V ALIDATE.1 UN THIS SPACE) T NIS IS YOUR PC IIMIT <br />A 111lr\IIPi1 M1U 1111.1f1 I`lANi l.11l{1.I II IIY, f Ml'I111YIII Il1A 1'LUAMIIIY <br />