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I <br /> I <br />� <br /> f ; U)a Erc/�Jlr'i'n .a_...�.�...._e,:.. �� <br /> =�TY �„ CONSTR UCTIOiV everet� � <br />; , eVeTett PERMIT ' <br /> ��.�.,�� ,�,F,,, I <br /> cvcnur c:as'.inr,rnv <br /> A;:u <br />' °"` °"°'"""';'^ BUILDING MECHANICAL PLUME3ING <br /> I OfvElOPttbll <br /> I I <br />, OWNEF MAILAD�NE55 ZIP PHONE I <br />' `r1h^`�"?i '�?i:'":�':'i I.i'X? i.??d: �v.. ���n:' � <br />� I ARCMITECT Ofi �ESIGNER MAIL�1DDRE55 PHONF. LICENSE NO. , I <br /> �,' <br /> GEN[RAL CONTRACTOR MlUL ADORESS PHONE LICENSE NO. <br /> MECHANICALCONTRACTOR MAILADDFESS PHONE LICENSENO. <br /> �j (? 4 <br /> PLUMeING CONTRACTOR MAIL A��RESS PHONE VCENSE NO. � <br /> W <br /> m <br /> i PEHMIT CLASS OF WORK <br /> � � <br /> ❑6UILDING � PLUMpING [{J.AECHANICAL ,�{ z I <br /> {�NEW ❑ADDITION ❑ALTERATION ❑RFPAIR ~ <br /> VALUATION OF WOFiK � <br /> S ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL w <br /> d <br /> �ESCRIBE WOflk --' 7(� <br /> ����t:v . _ � . . . :T� 1 4� <br /> PROPOSED VSE <br /> MECHANICAL <br /> _ rrve"orFue� �OIL QNAT. �LPG. �ELEC. <br /> LEGAL DESCftIPTIODI Of' PfiOPEi2TY (SIIOIV 13ELOW Ofi AiTACII C,AS � <br /> FOUq COPIE51 <br /> NO. TYPE OF E�UIPMEN7 FEE � <br /> LOT--_ �JLOCK_OF -- qIR CONO. UMTS-H.P. EA. 5 I <br /> � <br /> _�fiEFRIGEflAT:ON UNITS-H.P. EA. <br /> BOI�ERS-M.P. EA. � <br /> GAS FIRED A.C. UNITS-TONNAGE EA. <br /> ___ _ fORCED AIR SYSTEMS-B.T.U. M EA. I <br /> J08 ADDRESS Wl�LL HEATEG:-B.T.U. M <br /> � ��~`�� •� �5•:� �::�'� ,UNI� THEATEFS-B.T.U. M I <br /> � � EVAPOriATIVECOOLERS <br /> I PLUMBING CLOTHES DRYERS � <br /> I __ VENTILATION FAN I <br /> FANGEHOOD � I <br /> NO. TYPE OF FIXTURE OR ITEM FEE A�R HANDLING UNIT- C.F.M. I <br /> WATER CLOSETITOILET� g �NCINERATOP I I <br /> BATHTUB <br /> _ LAVATORVIWASHBASIN) � <br /> SHOWER —F —� — <br /> KITCMENSINK & DISP. SV3TOTAL 5 ��� <br /> DISHWAS'iER — <br /> PERMIT 5 <br /> IAUNDFY TRAY TOTl�L fEE 5 •� <br /> I CLOTHE'i WASHER _� TI:IS PEPMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br /> WATER MEATER TION AUTHORIZED IS �JOT COM1IMENCEO WITHIN 120 OAVS, Of� IF � <br /> URINC.L COPlSTRUCTION OR WORK IS SUSPENDED OR Af3ANDONED FOR A <br /> DRINKING FOUNTAIN PERIOU OF 1?0 DAYS AT ANY TIAtE AFTER WORK IS COMMENCED. <br /> FLOOR-SINK OR DRAIN I HERERV CERTIFV THAT I HAVE NEAD AND EXAMINED THIS AP- <br /> VACUUM BREAKERS -- PLICATION AND KNOW THE SAIdF TO BE TFUE AND GORRECT. ALL I <br /> pOOF JRAINS-RAINLEADEFS PROVISIONS OF LAWS AND ORDINFNCES GOVERNING THIS TVPE <br /> OF WORY, WILL [3E COMPLIED WITH WHBTHER SPECIFIED HEREIN <br /> SINK (SEIIVICE-�AR, ETC.) O!i NOT, THE GRANTING OF A PERMIT DOES NOT PRLSUME TO <br /> I _ _ GIVE AUTHORRV TO VIOLATG OR Cl�NCEL THE PROVISIONS OF <br /> ANV OTHER STATE OF LOCAL LAN' REGULATING CONSTRUCTION <br /> t_ OR THE PERFOFh1nNCE OF CONSTRUCTION. <br /> � SUB TOTAL <br /> PEHMIT 5 <br /> TOTALFEE 5 �,��♦ <br /> x 5i�+.v7f <br /> SIGNATUPEOFCONTfiACTORORAUTH.AGENT DATE <br /> SIDE YAFiD SETDACK STRC[T SETAACK qEAR YC,ROSET�ACh: PLAN CHECK NUM17C;ER MLAN CHECK FEE <br /> , FEE RECEIPT NO. <br /> I�,i USEZONE LOTAFEA VACANTSITE <br /> i ❑VES ❑No FEES VALUATION FEC <br /> TVPE OF CONST. OCCUPANGV GRJUP NO.OF DWELLING I <br /> UNITS � <br /> SIZE OF 6LDG. NO.OF STOAIES MA%, OCC. LOAD 6UILDING 5 � <br /> I <br /> i I <br /> I FIREZONF pASEMENT FIRESPRINKLERS PLVMBING i — � <br /> Ff�UIRED � <br /> I ❑VES ❑NO MECHAHICAL �pq � <br /> � I � <br /> SPECIAL CONDITIONS: OTHER � <br /> I <br /> PENEI_TY SEC. 9031n1 I <br /> I <br /> TOT4L � <br /> � __ �� Q�7 <br /> � PERMITVALIDATION <br /> � -- WHEN PROPERLY VALIDATE� (IN THIS SPACEI THIS IS VOUR PERMIT <br /> � <br /> I - <br /> i <br /> � <br /> i <br /> I �FPLIC�TIONACCEVTEOOV fVd:501CC.FUtfT nPPpOVEDF0AI5SlI�NCEOv. <br /> 1 <br /> � I 2i G• <br /> i <br /> — _ �� <br />