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!hr G t'erKreen ^ O N ST R U CT I O N <br />nir Gr � <br />everett PERMIT pERM,T �o. 11��3s <br />G7y 11ALL "15? v�45 <br />eveue�t e.'a �._,;>;� ❑ COMBINATION CJ BUILDING C�MECHANICAL C� FLUMBING <br />�V/NfN IAPIL4�'�JnLSS Cli�♦ �I fNC'li <br />R�xz nn �,_.yoRK 5416 [aFThfORF 355-078n _ <br />fN��M'II.GiORULSI(NEH M61lAppaLFC C'19 ZIP aNOYC <br />GENERFL(ANiRFGt09 �'^.I�CCr.CS�. QiY ZIP AIONE V,.;- <br />M[CNew[,ALVJtdW4�iOR IAAIIPppRE55 CIiY ZiP R10NC LtGEIiS� � <br />PI�EyON1R4CiON M�ILADDRESS LIiY 21P PNOHE IiCCLSL� <br />❑NLW <br />vAwnnor+or woR« <br />S <br />DESGP::i f.u�e <br />�ADDITION ❑AITERAiION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />LESAL DESCNiPT10N OP PaO�`CArY I` <br />�or e�ocK_o� _ <br />!C[� hPli��i,S <br />Sqlb WF.TMORA <br />PLUMBING <br />N0. TYPE OF <br />WATER CLOSET (IOILC <br />BATIiTU� <br />IAVATORv (WASH 00.5i <br />SHOWCa <br />1 KiiCH[N FINK 8 DISP <br />DISHWAS4/EA <br />i r.urvoar ranv <br />DRINKING FOI <br />(lOOR DRAIN <br />VACUUM PPE/ <br />ROOF DR>INS <br />SINK lSERVI"E <br />.il�( �nRDSET�FCK <br />F <br />i_ OF <br />I OF <br />I HEREBY GEHTIFY THAT I HAVE READ AND EXAMWED THIS AP� <br />vouncoviEs PLICATION AND KtJOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF IAWS AND ORGINANCES GGVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED VJITH WHETHER SPECIFIED <br />H[REIN OR NOT. TH[ �RANTING OF A PERMIT DOES IJOT <br />PFESUME TU GIVE AUTHORITY TO VIOLAT[ OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER ST�TE OR LOCAL L4W REGULATING <br />CONSTRUCTION OR TH[ PERfOFMANCE OF CONSTRUCTION. <br />S�GN�Gl�O'��1�4 �A� Hie[D/..LNT DPiI <br />X�`��: � 9 ZZ 82 <br />MECHANICAI <br />FEE <br />— PAML[A�ERS <br />— [1AR. F.TC � <br />SUBTOTAL 12 00 <br />PERMIT f _ jl� <br />TOTAL FEE : <br />STflEET 5B7BtGK R[AR VARD SEil3>'�.4 <br />LOT AHEA VACANT SITE <br />!iYES C:NO <br />O['GUPANL'Y GROUP I NO.OF DWELUNG UNITS <br />OF ST04n[S <br />� i'J /IRONMEN7AL CNECK LIST <br />r�ui�oiNc PUNs <br />-� FIRLNV�HANT �� <br />e nRE pqOTECTION Sv9fl�A <br />5 GqACING `` <br />y r. <br />N6. DAAINJ.GET— <br />-�T---- <br />N 7 [NVIf3EHJM�jTAL IMP�STATEMENT <br />(. � — <br />C�' 0 HEFLhiD I ICT <br />�FPPLICATI N�AIC BV ' ,�PLANS CMECKED EY <br />,�, � (� <br />� r� ' bw <br />— �—_'a <br />__ � <br />1u4:1 <br />BY <br />APPA FOfl ISSUANCE C�. � <br />bw <br />TYPE OF EOUIPMENT <br />1NIiS — H fl Gn. <br />❑nN IINITS — !iP EA <br />GAS FIRED A C. UNITS — <br />FORCCD /+iR S�STEMS — <br />VIAI l HEATERS — 9 T U <br />UNI7 IiEATCFS — OT.0 <br />RPNGEHOOD <br />AIR HANDUNG UMT — C f.M <br />STOVE <br />�dETAL FINEPLACE B CHIMNEV <br />SUBTO7AL <br />PERMIT _ <br />TOTALFEE <br />PL4N CNECK NUMf3ER <br />BUILDING <br />��l".1LlING <br />MECHA:�ICAL <br />OiHER <br />PIAv CnECk FEF. <br />f EE FLCCIF7 HO <br />VALUATION FEE <br />E <br />UBC <br />SEC.303�a) <br />!� PpOPf.RLY VFUDAT[D IIN THIS SPACF) THI515 VOUR PER�AIT <br />�asi SO 15.D0 -- � <br />r� <br />r� <br />,,,�,:I;^. RrCf:if'� �.., <br />., .. ,� <br />✓ . <br />A ... . . <br />H F <br />y r. <br />H � <br />N :- <br />� � <br />� . <br />a ' <br />� <br />� <br />a; <br />C" <br />� . <br />r; <br />F ' <br />� <br />J <br />a <br />� <br />Y, <br />� <br />� <br />