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i <br /> IT <br /> APPLIcitaiON FOR CONSTR}66TION <br /> PERMIT <br /> er reen <br /> YOF <br /> PVPIPIt }r. <br /> verett e �: <br /> IILDING DEPARTMENT <br /> I-S610 TO BE COMPLETED IN INK— PLEASE PRINT <br /> {: <br /> TENCSTEI�' AILAODnESS ZIP RIONE <br /> 'g2IC 'yCN1L� � Sh/NGJUOD6119a'o37 <br /> IANI MAIL ADORES. CITY ZIP PITONS ! <br /> I . <br /> IRTECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE I . <br /> ;14' C& Cc A/sT"/?L/c-ncAi l �f.x/� Ines//r,Tsl '/NNLaaov),, 104 912os7 <br /> IERALCONTRACTOn MML ADDRESS CITY ZIP MIONE LICENSE A <br /> I'i <br /> o<co <br /> '1NANICAL CONTRACTOR MAIL ADDRESS CITY ZIP MIONE LICENSE r4 <br /> i <br /> IMBINGCONIDAC•nR MAIL ADDRESS CITY 71P PHONE LICENSE• „ <br /> ISS OF WORK <br /> I NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITIONS WOODSTOVEIFRPLINSERT ❑ BUILDING RELOCATION <br /> MNl IMPROVEMENT OR INIEF�REWITLL ONLY O CONTACT PERSON AND .".E NO I. <br /> 'I1RAC7 PRICE OF WdiK <br /> bQ do <br /> ;CRISE WORK AND SQUARE FOOTAGE INVOLVED <br /> VF�A/ Sin/61-C F.f7/Ly //SO <br /> iPOSED V.E OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> �iA/3�/L7cIO/17L KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND {' <br /> ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH 1' <br /> ;AL DESCRIPIgN OF MOPERII'TBNOWN BELOW OR ARACII FOURCOPIEW WHETHER SPECIFIED HEREINOR NOT.THEGRANTING OFA PERMIT DOES NOT I <br /> 2 N/GrI(AYA//) pCK4 S PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> I V BLOCK of ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUC71ON OR THE PER- I. <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 R('W AND <br /> 296.200 WAG I' <br /> SIGNATURE OF CONIRACIOR OR AUINORIZEO AGENT DATE �' l7� IT <br /> IJECT AD Ess APPLICANIS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br /> �✓crc:7y w,a 98 a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURF OR ITEM FEE NO. TYPE OF EQUIPMENT FEE j <br /> 1 WATER CLOSET(TOILET) — A/C—/VHNDLO UNITS—H.P. r <br /> :Z BATHTUB FORCED AIR SYSTEMS—S.T.U. _Mi EA <br /> I•. <br /> ,9 <br /> LAVATORY(WASH BASIN _UNIT HEATERS—ST.U. M h <br /> SHOWER CLOTHES DRYERS r• <br /> I KITCHEN SINK B DISP. _ VENTILATION FAN — <br /> I, <br /> DISHWASHER _L RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER li <br /> CLOTHESWASHER WOOD STOVE _. Ii'. <br /> URINAL METAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS _ GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUSTFAN —_ H <br /> SINK(SERVICE—BAR ETC) <br /> 1 <br /> SUBTOTAL S SUBTOTAL & <br /> PERMIT & — PERMIT S <br /> TOTAL FEE III TOTAL FEE <br /> IONI SETBACK PEAR SETBACK SIDE SETBACK MAN CNE KNUMBL F![ R!C[IR NO. I, <br /> "301 � ' s ' c' g`1 aa�� f5 acs��l3 ; <br /> 'IE ZONE LOTAREA III VACANT BNE FEES VALUATION FEE <br /> I\ - 1 - �'� YES ONO <br /> 'C BUILDING 53 <br /> M OF CONST. OCCUN NCY GROUP NO OF DN'EIIING UNIFY; <br /> LowAetuAciuAL K.,- / _ PLUMBING _ __.•" __ f <br /> •IE or BLDG. JL- NGOFeTO11*3_,A <br /> YT. MU LwD MECHANICAL ED <br /> 11 rC. / AN ; <br /> 443 6ACA4eS NEgIII LIWIAIgN OTHER — I <br /> //S' F <br /> ME SPRINKLERS REWIOED OYER yL/10 v� STATE BUILDING SURCHARGE r <br /> I 4' <br /> STATE ENERGY SURCHARGE Alt ' <br /> "PLICATION ACG BY PLANS APPR By O E <br /> PUBLIC WORKS <br /> L� TOTAL <br />