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CONSTRUCTION <br />PERMIT A IDLIC AT IOt, ! <br />COMBINATION II BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL AUUII"4 <br />ZIP PHONE <br />-T'9101tP47Rich- a11_o <br />9� 9�10� 353 -a93g. <br />A�RCNITLCT OH DESI(:NtH MAIL ADDRESS <br />PHONE LICENSE NO <br />DENE/R L CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NU. <br />306Z i>-' <br />�,� >> 5- <br />MECHANICAL CONTRACTOR _ MAIL AODnESS <br />PHONE LICE N$E NO. <br />PLVMBING CONTR ACTON MAIL ADDRESS <br />PHONE LICENSE NO. <br />PERMIT <br />CLASS OF WORK <br />-- - <br />❑COMBINATION <br />❑ DUILDING ❑ PLUMBING ❑MECHANICAL <br />❑NEW <br />❑AOOITIUN ❑AL TE RA fIUN ❑11L 1'A111 <br />VALUATION OF WORK <br />/. O <br />❑OEMOLISH <br />❑FENCE ❑SIGN ❑'AVIMMIN(i POOL <br />S V <br />OESCF/IUE YT RK <br />D <br />PROPOSED USE <br />OTHER PERMITS OR APPROVALS <br />( REZONE SPECIAL USE <br />jLLGAL DESCRIPTION ION OF PROPERTY (SHOW <br />BELOW OR ATTACH <br />,COTU.j.Carrt§I <br />�LCT•?—'BLOCK— OF+I-1�-cv ���" •-- •_ <br />VARIANCE 1- SIHORLINE <br />+-j• �-I <br />��'d{ <br />SE PA CHECK LIST P.EOUIRED <br />I:" YES <br />=j NO <br />L <br />JOB ADDRESS <br />_ <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY <br />❑nAt; ❑ELF. C. <br />_ _ TYPE OF EQUIPMENT _ _ _ _ FEE <br />NO. <br />AIRCONO._UNITS-H.P. FA_. S 1_ <br />REFRIGERATION UNIrS HP.EA. - —� <br />H.P. Ea,-------�--• <br />FORCED AIR SYSTEMS B.T.U..MEA. <br />SPACE & WALL HEATERS H.T.U. -�T— <br />NO. <br />TYPE OF FIXTURE OR ITEMI <br />FEE <br />--COiIERS <br />HA1H TUBS <br />is <br />CLOTHES WASHER-'-•�— <br />DISH WASHERS <br />DRINKING FOUNTAINS <br />i <br />FLOOR DRAINS <br />I I <br />KITCIIFN SINKS' & OISP. <br />I <br />UNIT HEATERS H T.V <br />1 <br />HAIL SINKS <br />I <br />_ <br />EVAPORATIVE C_OOLER_5�— <br />ROOF DRAINS 'RAIN LEADERS <br />I <br />CLOTHES DRYERS <br />I <br />SHOWER BATHS I <br />VENTLATIONFAN <br />_ <br />SE RVIC:E SINKS <br />RANGE HOOD I <br />SUh1VS SEWAGE PUMP <br />_ -�- <br />_ URINALS I <br />AIR HANDLING UNIT C.F.M. _ <br />_ _.._-`._-.__ .__.. ...•_._- ..-__ ' <br />WATER CLOSETS <br />_ <br />--T—' <br />WATER HEATE ITS -ELECTRIC ' <br />..._ WATER HEATER___T--- <br />WASH -BASINS I <br />FA C. BUILT FIREPLACE A CHIMNEY_ <br />LAUNDRY TAYSR_ <br />G.AS�SYSTEM ti OP OV TL[.IS T <br />_.._• <br />. .. ..-•-_.-L— <br />•- S. Ufi iU fAL....s. <br />1 <br />PERMIT <br />SUR TOTAL <br />TOTAL FEE S _ 1 <br />PERMIT <br />THIS PERMIT BECOMES NUI 1, AND VOID II WORK OR CONSTRUC <br />TOTAL FEE Si$I <br />TION AUTIIORIZED IS NOT COMMLNCED WITHIN 1?0 DAY!:, pH IF <br />— <br />CONSTRUCTION On WORK V; SU!Wl NOED nil AOANOONED FOP A <br />WATER SERVICE SIZE__BLDG SUPPLY SIZE <br />PERIOD OF 120 DAYS AT ANY TIMF AV TER WORK I::COMMENCLU. <br />.w <br />H i s� Ln ❑Lt a UACK HkAH YANU St iHACA <br />I IIEREIIY CERTIFY THAT I IIAVE HEAD AND EKAMINIn TIII: AP <br />I'LICATION AND KNOW THE SAME TO IIL TRUE ANO COHHTCT. ALL <br />PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE <br />USL ZUNt LUl AHLA VACANT SITE <br />OF WOIIK WILL BE COMPLIED WITH WHETHER STPECIFIEU HEHEIN <br />OR NOTT11E GnAN:ING OF A PERMIT nnE$ NOT PRESV ME TO <br />OYES ONO <br />GIVE AUTHOPITY TO VIOLATk (114 CANCEL TIRE Pn0V151ONS OF <br />ANY OT"En STATE Oil LOCAL LAW REGULATING CONSTRUCTION <br />F <br />TYPE OCONST. OCCUPANCY GROUP NOOF DWELLING <br />OR THE PL nF ORMANCE OF CO NSTfIVCl10 N. <br />UNITS <br />512E OF BLDG. NO. OF STORIES MAX. OCC. LOAD <br />- <br />1 llit ZUtVt UA(It ML N- /IHt .':1911NKl LIIS <br />SIC;PAT URE OF CONTRACTOIOH AUTII. AGLNT DATE <br />• REOUIHED <br />❑YES ❑NO <br />IL..NLIILCK NUAt11L14 {`pp I'LANCIILCN ILL <br />FLE RECEIPT Nil <br />SPECIAL CONDITIONS: <br />- <br />a <br />FEES [ VALUATION FF..E <br />BUILDING i I <br />SEPA REVIEW COMPLETE: DYES ❑ NO <br />Pl tIM111 N11 <br />COn1oCf plannlnq dept. MLCIIANICAL--« 1 1 <br />OTHER 1 <br />I <br />WOUTNN µI I T I IU tY ruMi Le LLaLU Y wAUY1D Ue�ItY <br />_ <br />PENALTY SEC. 30:11s) --T� <br />1 j <br />TOTAL I <br />