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PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /l OD 4 1,__./.11 l PLAN NO.
OWNER PA J Z e7 1- j z/L^ s
DESIGNER
/ l
USE /NATURE OF WORK _ -, _ ( 0 ! _ /'�,frie t
..
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT - WH + Disp WSoft CBasin
Lav - Sh / DW DF
Z San. Sewer
3_
3 WC FDr _L SP Ur Storm Sewer
Sink L Crolk Eject SS Water
Other
/ X Y
FEES: Valuation $ 5- 7 2 -- (Y D Permit Fee Paid $ 6
Park Dedication $
ISSUED BY , fig Date e 7 " c c-7 62 Final /O.P. //
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE I■ , / r
AGENT /OWNEF
DATE
ADDRESS
TELEPHONE #
PLUMBING RMIT APPLICATION
ADDRESS 4‘,97/ /71:5::, ` ../r4.---*
r Y ,-,. • DATE 6"---...? er PERMITO // ?Cr
OWNER , 2- 'y c'( -- 4 ? PLUMBER PLUMBER ;o... 3a�
NATURE OF WORK A`�, 5
NEW RELAY REPAIR INTERIOR
-
SAN SEW I #
WATER 1 / Bathtub ' Catch Basin
STORM SEW1 1 Lavatory () p Grease Trap
Toilet ►p 1 1 Sump Pump 1
EC
INSPECTION DATE INSPTION DATE / Kit. Sink 1 I Local Waste
VI / ' Sink(other) Site Drain
` 6 i 1 Shower IL ) Laundry Stand Pipe
3 Floor Drain 1 ,Laundry Tray
/�j I 1 Disposal wash D ntai
4'
� l ( � J / L,� 4 _"_ � S � 1 Dishwasher 1 D. Fountain
in
�1e 1 Water Heater' Ejector
7 1 Urinals Future outlets
lulu/pi i 1 , 4,f4,,,, /er 1i A , >�
I** Violation Motes on the reverse ,aide]