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CIIYDI- C'.)NS T RUC k IONPERMIT <br />LVl'i'L I_i <br />1 <br />CI I IInIt Al 12345 <br />I VI NI II, Wn:u,rl Sl Dx <br />j 5l)01 <br />I DIPr.OFWVVU'IltY BUILDING MECHANICAL PLUMBING <br />DCn l4vvtxr <br />�UWNLR �' MAIL ADDRESS zil/^ PPHUUNL <br />ARCI -L OR DESI E MMI. AOUR E"S PHONE LICENSE NO. / _71 <br />GLIDE IIALC Yif5ACT R� / ,.-/ MAIL ADORES S\ I'IIONE LICENSE NO. <br />do V/�/ UY&uze �G�S��p(1,/�$��1C [ p SZ/G/off G/�/7% <br />MECHANICAL ONT RAC'fOjI LGLL�7�LLLPO lnGGli� PHUNC- LICENSE NU. <br />PLUI IRNG ¢p:J R MAIL ADDRESS PHONE LICENSL' NO. uJ <br />V .�- <br />PERMrr CLASS OF WORK M <br />L <br />]BUILDING ❑PLUMIHNG ❑MCCHANICAL ❑NEW ILIA/ION ❑ALTERATION ❑REPAIR <br />VALUAT rl OF WORK <br />r,❑DEMOLISli ❑FENCE ❑SIGN ❑SWLn4MING POOL LU <br />UESCI1i0E O11K. / <br />A <br />PROPOSED USE MECFIANICAI_ <br />TYPEOFFUEL ❑OIL ❑MAT. ❑LPG. ❑ELt C. <br />LEGAL DESCrUPTION OF PROPERTY (SHOW BELOW OR ATTACH GAS <br />1 FOUR COPIES) -- <br />I <br />LOT BLOCK —OF NO, TYPE OF_ EQUIPMENT _ FEE <br />AIR COND. UNITS—II.P. EA. S I <br />REFRIGERATION UNITS--Ii.P. EA. 1 <br />BOILERS—H.P. EA. <br />GAS FIRED A.C. UNITS —TONNAGE EA. I _ <br />_ FORCED AIR SYSTEMS—B-T.U. M EA. I_ _ <br />' JOB ADDRESS WALL HEATERS—B.T.U. M —( <br />UNIT HCATERS—B.T.U. M <br />IEVAPORATIVE COOLERS <br />PLUMB!NG CLOTI4 ES DRYERS I <br />{ VENTILATION FAN <br />I— <br />_ RANGEHOOD I <br />NO. TYPE OF FIXTURE OR ITEM FEE AIR Iin NOLING <br />I I <br />I _ WATER CLOSET (TOILET) S � INCINERATOR --- <br />i <br />UATHTUB I -I i - <br />SHOWER <br />(WASH BASIN) _ <br />SFIOW ER _ <br />I <br />KITCHENSINK & DISP. SUBTOTAL S <br />D1 _ <br />— ISHWAS11WASIIER PERMIT $ <br />LAUNDRYTRAY TOTALFEE S I <br />_ CLOTHES YfASHER I_ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />WATER HEATER TION AUTHORIZED IS NOT COMMENCED N1ITI11N 120 DAYS, OR IF <br />URINAL I� CONSTRUCTION OR WORK iS SUSPENDED OR ABANDONED FOR A <br />DRINKING FOUNTAIN I PERIOD OF 420 DAYS AT ANY TIME AFTER WORK IS COI.IMENCED. <br />FLOOR —SINK OR DRAIN �— I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />VACUUM BREAKERS PLICATION AND KNOW THE SAT.IE TO BE TRUE AND CORRECT. ALL <br />_—i - PROVISIONS OF LAWS AND ORDINANCES ''-rV ERNING THIS TYPE <br />ROOF DRAINS—RAINLEADERS t <br />PR WORK WILL BE COMPLIED WITH WHET HE17 SPECIFIED HEREIN <br />( SINK (SERVICE —BAR, ETC.) l OR NOT, THE GRANTING OF A PERMIT DOES `IOT PRESUME TO <br />—� GIVE AUTHORITY TO VIOLATE OR CANCEL THE r"IOVISIONS OF <br />I ANY OTHER STATE OR LOCAL LAL'I REGULATING CU( STRUCTION <br />— I OR THE PERFORMANCE OF CONSTRUCTION. <br />SUB TOTAL <br />PERMIT S <br />TOTAL FEE $ 1 <br />CITY USE BELOW THIS LINE SJOITATUnE OF GDNT R`A�YFOR OR AUTH. AGF DATE <br />SIDE YARD SETBACK ST FILET SETBACK FILAR YARDSETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE LOT AREA VACANT SITE -7/3 &15 <br />OYES ONO FEES VALUATION FEE _ <br />TYPE OF CONST. OCCUPANCY GIIOUP IJO. OF DWELLING --r <br />UNITS 1 <br />1 <br />SZBLod.--WU.OF STORIES MAX, OCC. LOAD BUILDING <br />I IE OFI . <br />PLUMBING 1 <br />I'IRE ZONE I'in.SE M1tENT IjEnuPRINK <br />REO1 <br />OYES <br />YEs ONO MECHANICAL , <br />SPECIAL CONDITIONS: OTHER <br />_ I <br />._—__ --- PCNELTY SCr. 303 (a) I <br />_ I — <br />_. '--- -- TOTAL {-- — <br />i — <br />PERMIT VALIDATION <br />WHLN PHOPL I SLY VALIDATED I IN THIS CPACEI T 141511: YOUR PERMIT <br />nPPt¢AIM1M nlC11'IIDnY Plntl;l.11lt'FI TiY N1'Inlv[1110 IS`•UnrnAily <br />I <br />