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UIY(it <br />ever.oft <br />GI• untl )1,1484s <br />11 I"ll( 11. N4;v,yp 10N <br />17T11 <br />I sl rr. cr ;Lv:•nrulY <br />R :110^91 Nt <br />Q.) PERivirr <br />BUILDING MECHANICAL <br />PLUh.1BING <br />L 1 y� MAIL /,�/AUGHLSS�1 o/[//Z/II�J I•IIONI. <br />L_L/�%f n!.CC/7 LL'/7al — <br />ARCHII'LC'I Olt OE'IGNLR MAIL_ ADUtm ;SS PHONE LICENSE NO. <br />j (`{LN61tAL CUIITRA Oli, MAIL AODRL. PRUNE LICENSE NO. <br />h7ECHANICnL CONT PACTO II MAIL ADDIi LSS I'110NE LICENSE NO. <br />III PLUMBING CONTiAAJCCIOH h7AIjL ADDRESSj PHONE LICENSE tip. <br />le <br />DI <br />P RMI' <br />`/ <br />❑ OUILDING [)PLUMBING ❑ MECHANICAL <br />CLASS OF WORK <br />NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />7 <br />z <br />VALUATION OFWORK <br />�� <br />�XY JJC,JQ�L,y Cp <br />❑DEMOLISH ❑FENCE ❑SIGN ❑S'NLIAMING POOL <br />LU <br />a <br />DescRLB- woiill <br />Ce' <br />rRoros /D//}/y�si: <br />MECHANICAL <br />FOUR FOUOEICir PTION OF PROPERTY IS HOW L'CL W OR ATTACH <br />R CO PIESI / <br />LOT.,Cj___BLOCK.—OF /'/dr o <br />J <br />kza CI FS �/% :% / <br />TYPE OF FUEL ❑OIL ❑NAT. ❑LPG. ❑ELEC. <br />GAS <br />NO. <br />_ <br />TYPE OF EQUIPMENT <br />FEE <br />IAIR <br />COND. UNITS-H.P. EA. <br />_ <br />$ •J <br />REFRIGERATION UNITS-Pi.P. EA. <br />_ <br />BOILERS-H.P. EA. <br />1 <br />GAS FIRED A.C. UNITS -TONNAGE LA. <br />FORCED AIR SYSTEMS-R.T.U. MCA. <br />I <br />.loo ADDRESS (— I �, <br />U o�_?l-L I•' -/ <br />- <br />WALL HC ATE RS-R.T.U. III <br />--I- <br />UNIT "EATERS-B.T.U. M <br />I <br />PLUMBING <br />� <br />EVAPC RATIVE COOLtr 4S <br />CLOTHES DRYERS <br />IP!O. <br />_ <br />(.2 <br />TYPE OF FIY.'i UI1E OR ITEM <br />Al'FR CLOSEI'('I OII-LTr <br />FEE _ <br />VENTILATION FAN <br />(e <br />RANGE HOOD <br />i I <br />— <br />AIR HANDLING UNIT- C.F.M.I <br />INCINCRATOII <br />_ <br />riva <br />�Lnvnl <br />'� <br />Dln Rvnsit unslN3 <br />Sf10R'Eft ///k (ill.e IGH <br />KITCHEN SINK & DISP. <br />O I;.HL\_A$IiER <br />LAUNDRY TRAY <br />�--•-T <br />--(: <br />— <br />SUBTOTAL <br />-- I <br />PERMIT SCLOTH <br />TOTAL FEE S <br />- �- <br />T <br />-' - <br />Ht <br />;� 11:. <br />WATEI31fEATER <br />WATEri HE Ati <br />/. _'�- <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC. <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS Al ANY TIME AFTERWORK IS COM IENCED. <br />I HEREBY •LrITIFY THAT I H,kVE READ AND EXAMINED THIS AP. <br />PLICATION . NO KNOW THE SANE TO EE TRUE AND CORRECT. ALL <br />PROVISIONS -F LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF RW <br />WORK YJIL . C COMPLIEU ITH WHETHER SPECIFIED HEREIN <br />OR NOT, 1HE GHANTINO OF A PERMIT DOES NOT PRr.SU`.7E TO <br />GIVL AUTHORITY TO VIOLATE OR CANCEL TI4E PROVISIONS OF <br />ANY OTHER STATE OR LOCAL_ LAW 8EGULATING CONSTRUCTION <br />OR l'IJE PERFORMANCE OF CONSTRUCTION. <br />U. TBCITY NA U ONF <br />XUSE <br />__ <br />URINAL <br />-- <br />— <br />DRINKING FOUNTAIN <br />_F1.007-SINK OR DRAIN <br />_ <br />\'ACl/U1.1 GR[AKE RS <br />ROOF DRAI:JS-RAINL[ADE RS <br />—1--- <br />- <br />SINK ISE RVICE-OAR. ETC.) <br />---I <br />-----'I <br />--I-- <br />-_ <br />- SIJr TOTAL <br />PERMIT <br />$ 7.%'c;Io <br />TOTAL FEE <br />g %K$Ip0 <br />BELOW WITS LINE <br />SIDES 1ARDSETSACK <br />SIRELTSCTBACK <br />_ <br />HEAR YARD SE'CBACK <br />_ <br />PLAN CHECK NUMBEllT'-.�V�V/(_N <br />CHECK FEE. RECEIPT NO. <br />3gVSL' <br />LUATION F[E <br />ZONE <br />LO"T ARC:A <br />VACANT SITE:©YES ❑NO <br />FEf.S <br />YPL OF CONST.00CUPANCY <br />GROUP NO. <br />UNITS <br />OC DWELLING <br />/ <br />_ <br />_ <br />I <br />m l: OF BLDG. <br />NO. OF STORIES VAX. <br />f. <br />OC. LOAD <br />BUILDING <br />$.-2 '01�, <br />--' I --- <br />A, 1 �J <br />PLUMBING <br />FIRE ZONE <br />3 <br />RAsr M L N'C FIRE <br />(� II <br />T <br />SPRINKLERS <br />E(1U1 RFD <br />❑Y Ls (J rvO� <br />--- <br />MECHANICAL <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />SEI'.:70J lal <br />._I-- <br />I <br />TOTAL <br />21 <br />— <br />-- -- —_._ <br />PERMIT VALIDATION <br />WHIN P"OPLHLY VALIOATI711 L N I IIIS V; YOUR PLIIMIT <br />— � — ----- - ----- <br />nl1'LICAI LLiN ALCI I'll Pifl' 1'I ANi LIILI'AI II IIY: M1I'I•IlgVf i11 111IHUnln ItY,' <br />H•w.M• <br />„ I l h ',f; 1 I I' I <br />