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<br /> "' Y "' C('iNST�UCTION e�verett i
<br /> �' �y��`,�� PERMIT � i
<br /> F�FAE�, ���t„��,,,,: �
<br /> �::�, �
<br /> °`�` °``°""°',"" BUILDING '
<br /> °E°E�°�°�.,, MECHANICAL PLUMBINu '
<br /> OWNER
<br /> . MAIL ADDHESS Z1P
<br /> �. �':.i::l;: �P,f., :�` � PV'ONE I
<br /> . _. .�7. it 'I nlry�
<br /> ARCHITECT OR DESIGNER ^ • O,, '7 �� � ' "' - ' ' ' l S �_�') I
<br /> MAIL ���-�' ' ! •.' . .. ..
<br /> ADDHE55 PHONE
<br /> LIC'NS[ NO. i
<br /> GE-NERALCONTRACT— pq— I
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<br /> Ml�11.qODflE55 PHONE �
<br /> LICEfv„C :JD.
<br /> MECHANICALCONTRACTOR '�t� V� t�� '':.)�;' I
<br /> � l MAILADOFESS PH�Nt • I
<br /> •��='.j'.-�- .•'.i:f:.lT.^( LICENSEIJO. •
<br /> PLVMBING CONTRqCTOR
<br /> �'JI_I.f!_^:':��:� MAII ADOflCSS
<br /> . . i-Zt,�,�i?����C� PHON[ �ICEN;[ Nn. � .
<br /> P[RMIT W
<br /> CLASa OF WORK � i
<br /> � I
<br /> ❑�UILDING � PLUMBI4G =
<br /> ❑MECHANICAL z
<br /> VALUATIONOFWORk �NEw ❑ADDITION ❑/�LTLRATION ❑REpFlIR I- I
<br /> " ;' . .t�; ,. _. ' — � I
<br /> s ❑OEMpLISH ❑SIGN I
<br /> DESCRIBE WOqK ❑FENCE ❑SWIMMING POOL W
<br /> .,�;;: : _�
<br /> ------ a I
<br /> ::T'.t�.. . E�A71C �$:_�ii`: 1'Ci:ili..::;-.� .
<br /> PqOPOSEp USE � ���� �
<br /> ��-���.�` f"r"�Z-' F��j.,:i�1CC MECHANICAL � �
<br /> LEGAL UESCRIPTION OF PROPERTV (SHOW 6ELOW O^ pTTACH T�PE OF FUEL �pIL I
<br /> FOURCp�IESI �NnT. �LPG. �ELEC.
<br /> 1 G/15
<br /> •Or HLOCK_OF ?,nIItttA=F1 V1r_t* ""? No. I
<br /> TYPE OF EDUIPMEN7 FEE �
<br />� AIR CUND. UNITS-H.P, EA. , 5 I
<br />/ REFRIGERATION UNITS-H.P, Eq, �
<br /> I DOILERS-N.P. EA. I
<br /> C%��C� GAS F".RED
<br /> A.C. UNITS-TONNAGE Eti� I I
<br /> L__—
<br /> i J0f3 qDowC:.c _ __. " FORCED AIR SvSTEM;B.T.U. M EA."^ � �� .�
<br /> . . . t i .:... .:':t!:'7;',':' .�._.. _�WALL MEATERS-B.T.V. "
<br /> M
<br /> _ UNIT ryEATEqS-6.T,U, M
<br /> PLUMBING EVl�POFATIVE COOLER$ �
<br /> CLOTHES UqVEft$ �
<br /> ` VENTILATION FAN � I
<br /> RANGEHOOD--� '
<br /> NO. TYPE OF FIXTURE OR ITEM FEE A�R ��nNOLING VNIT- � I �1 '
<br /> _ WATER CLOSET �TpILETI 0.F.M. T �
<br /> DATHTU9 5 �NCINERATpq I
<br /> , I
<br /> LAVATORY(WASH F3ASIN) I
<br /> SHOWER 4 —
<br /> KITCHFN SINK& DISP, `�' `�'� __ � ,
<br /> DISHWASHER y ��- SUBTOTAL 5 .,`� . +
<br /> I _ ll�UNDRY TRAV __ _ �' PERMIT -- . .
<br /> F 5 y� I
<br />( CLOTHESN'ASHER �OTALFEE 5 '31 "'' I
<br /> i _— WATER HEq7�Eq THIS PERMIT �ECOMES NULL ANO VO10 IF WpRK Oq CONSTRUG �
<br /> URINAL � I ^ TION AUTHOiiIZED IS NOT COMMENCED WITHIN 120 DAV
<br /> DRIIJY.ING FOUNTAIN CONSTfiUCTION OR WpRK IS SUSPENDED OR ABAIJOONED FOR1A
<br /> FLOOR- P`-��OD OF 120 DAYS AT ANY TIME AfTER WOHK IS COMMENCE�. I
<br /> � SINK OR ORAIN
<br /> VACUUM BREAKERS � HEREBV CERTIFV THA7 � HAVE READ AND EXAMINED THIS AP-
<br /> i ROCF CRq�NS-qq�NLEADEflS P��CATION AND KNOW THE SAh1E T�O BE TtiUE AND CORRECT. ALL �
<br /> �--}—�— PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TVPE �
<br /> i SINK (SERVICE-F,AR, ETC.) �{---- �F N10RK WILL BE COkIPLILD WITH i
<br /> O!1 NOT, THE GqqNTING OF q PER�TEDOES NO"fCIPRE3U nE TO I
<br /> � GIVE AVTHORITV TO VIOLATE OR CANCEL THE PqOVIS10N5 OF I
<br /> n ANV OTHER ,�TATE OR LOCAL LAW REGULATING CONSTqUCTION
<br /> I SU� TOTAL .. ..,. �R THE PERFORMANCE OF CONSTRUCTION. �
<br /> � PEFMIT 5 �-}+;-.--
<br /> I ___ TOTAL FEE S . .� I i
<br /> �.. I
<br /> x 7/%`-r/7"1
<br /> � SIGNATURE OF CONTRACTOR OH AUTH.AGENT
<br /> I SIIIEY/�p�SET�qCK STREETSY7�J CK n/�TE I
<br /> t. Ni3�) REARVAR��.9�T�l�CKPLr1NCHECKNVMBER
<br /> PLAN CHECK FEE
<br /> USE ZpNE / FEE RECEIPT NO.
<br /> i LOT R VAC NTSITE 77J '3-�� 7���'J:: �) ��iYf
<br /> ;t-•1 `���Z ^�t. F t1, �
<br /> I �OVES ❑NO FEES
<br /> I TVPEO' ONST. OCCUPANCVG,jiOUP Np,pFDW@j.LINF VALUQTION FEE
<br /> �� � i UNITS �
<br /> 1
<br /> i
<br /> � SIZF O° 8'�DG., i NO. OP STpqIES MqX.00C. LOA� OUILDING
<br /> ���.� Y1� � g � '-� / � ... 9C11 �:j
<br /> f �
<br /> FIHEZONE RqSEMENT -IqESPqINKLE S PWM6ING ��1 ����
<br /> ' •� ^':rr.f?�, REOUIRED y� �
<br /> ' ❑�ES �NO MECHANICAL I
<br /> � SPECIALCONDITIONS: 1 ��
<br /> ' -�r+1113?` � ;lV U .I(:ti:t;; .1 DO ^��i "� OTHER 1
<br /> C�l � �QQ„ t:�33�9II1c?:�t !] OS3C3 iYQULIi PENELTV SEC. 3031a1 �
<br /> � t' : �.
<br /> , . . � y . • TOTAL �:J.,I L
<br /> i ':o nart an o . house to i:ca i�;i_'_� �
<br /> � — �-''+��.'L PERMIT VALIDA710N
<br /> �, �-°s�g�L'�f:i2t. —'— WHEN PROP@RLY VALIDATEO (IN THIS gPqCE1 THIS IS VOUR PERMIT
<br /> I %�I'PLiC�TIprypCCEPiFOlIY� VLAqSC'ELREOpY:
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