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'� 7/�e Ev�ri,u��i'rr <br />I�:�,�,�� <br />� e�e:rett <br />�„� �:.<< �s�,aa�, <br />eve xtn. rmsiuu; t m: <br />acrn <br />OLPI OI LI1C•In':n'� <br />OFV�IOfr: ;� <br />i OWNEF�. <br />� .CStIY: ' � .. . _ .. <br />::t:�z� :�:3 <br />BUILDING <br />�ONS`i'RUCi�O�d <br />PER�VIIT <br />P�IECHANICAL <br />SS..+......y.,�. <br />� .. _ .: s <br />PLUMBING <br />��� w :��.i'i,i L.'V �7i?��aAi� ;'iiti - �f.11tN'� ���Z�!.V ia�..J�yw�1.-,. <br />MAIL ADORESS PHONE LICENSE NO. <br />� 6UI�pING � PLUMBING � MECHANICAL <br />VALUATIpry (��l+�UjIS <br />;F?�f,A �11U <br />5 <br />DESCRI FAYJOF� �:� s <br />�=I � .�� :i'=+3 .!.�Wi <br />f RfJVOSED USL � <br />❑NENI '[JAOOIi'iON ❑(�LTEFl1TION ❑RLPAIR <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWtMMING POOL <br />FOUR C�SIIPTION OF PROPEHTV ISHOW BELUW OR ATTACH <br />LOT OLOCK_OF <br />�.t!fi�,.� ;�,��5 F.�i :`fl '`V�'G'.` :'� <br />JOBA�DRE$6�,,.��, ^ � <br />c,�,.. �';..1 .. . _ . <br />F'LuivItSING <br />T ___ <br />I <br />NO. 7YP[ OF FIXTURE OR ITEM <br />WATER CLOSFTITOILET� <br />�ATIITU� <br />LAVATOPYIWASNBASIN� � <br />_ _ SHOWER <br />_ KITCHEN SINK & �ISP. <br />DISHWASHER <br />LAUNDFVTRAV <br />CLOTHESWASHER <br />WATFR HEATEF <br />URINAL <br />GflINKINGFOUNTAIN <br />fLOOR-SINK OP ORAIN <br />VACUUM BREAKGRS <br />HUUF URAINS-PAINLEADERS <br />NIECHANICAL <br />1vr�EOF-ruEi_ ��ii_ -Orvn <br />GA <br />N�� TV'PE OF EQUIPI <br />AIR COND. UNITS-H.P. EA. <br />n�rniceannoia urvirs -i� <br />UOILEHS-H.P.EA. <br />-{IGl�S FIRED A.C. UNII'S�-TO <br />-I FORCED AIR $YSTEMS-B.7 <br />__� WALL HEAT[RS-3T.U. <br />I UNIT HEAiERS-�.T.U. <br />i [Vl.PORFlTIVE CU�L[�i5 <br />CLOTHESORVERS <br />_ VENTILATION FAN <br />RANGEHOOD <br />AIR HANOUNG UNIT- <br />INCINF.RATOFi <br />� 4�3 <br />T. � LPG. � ELEC. <br />5 <br />�ENT FEE <br />s � <br />a. Ea �— <br />� <br />I <br />VNAGE EA. --�-- <br />U. M EA. � <br />M <br />M � <br />—T <br />-r I <br />I <br />—"T <br />' <br />C.F.M. <br />� <br />W <br />m <br />c <br />� <br />z <br />H <br />� <br />� <br />I SUBTOTAL 5� <br />_ PERMIT 5 , <br />TOTAL FEE $ � <br />THIS PERMIT BECOMES NULL t�ND VO10 IF WORK OR CONSTRUC� <br />TION AUTHOflIZBO IS NOT COMMENCED WITHIN 1?0 DAVS, OR IF <br />CONSTRUCTION UR WORK IS SUSPENDED OR A��INDONEO fOR !1 <br />PEFIOD OP 120 DAVS AT ANY TIME AFTEfi WORK IS COMMENCEO. <br />I NERE�Y CERTIFY l'HAT I HAVL HEAO AND GYA^AWED THIS AV� <br />PLICATION AND Y.NOW THE SAM11E TD �F TRUE AND COFR@CT. AlL <br />PFOVISIONS OF lAWS ANO ORDINANCE$ GOVERNING THIS TVPE <br />UF WORY, WILL OE COh1PIJED WITH VlHETHER SPECIFIeD HEREIN <br />CH NO1, THE GRANTING OP A PERAIIT DOES NOT PNESU�IE TO <br />GIVF'. l�UTHOflITY TO VIOLATE OR CANCEL THE PFiOVISIONS OF <br />ANl' OTNER STATE Ofl LOCAL LN,N FiFGULI�TING CONSTRVCTION <br />OR THE PEFFORMANrE OF CONST(9VCl ION. <br />� L.. L.. <br />x <br />SIGNATUF? OF CONT'� <br />5[TUACY. STRE�T SET6ACY, qEAR VARDSET�ACK PLAN CHECK NUM1AI3ER <br />����� <br />IOTAREA VACANTSITE <br />❑vE5 ❑Nu FEES <br />SPECIAL CONDITIONS' <br />nOY[ 0 ft111 Iq• <br />PLAN CHECK FEE <br />FEE���-yF.J RE�►'MyO. <br />d� <br />VALUATION FEE <br />T <br />JAD RUILDING $ �3�*�.�NMr'V�i 1.{4 i{,R,n' <br />PLUMBING I <br />LER$ � <br />MECHANICAL � <br />❑NO � <br />OTHER I <br />_ I <br />PENELTY SEC.303(:.1 I <br />TOTAL � � <br />PEftMIT VALIDATIOf: <br />- WHEN PqOPERLY VnLIpATE� IIN THISSPl�CEI THIS IS YOUR PEfl�dIT <br />