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BRCv� BUILDING DEPARTMENT EC E 0 WE
04,:"T( 'N•` y VILLAGE OF RYE BROOK D
r:k � 93 8 KING STREET RYE BROOK,NY 10573 j
(914) 939-0668 FAX (914) 939-5801
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w,ArA,.ryebroolc.org
RYE BROOK
BUILDING DER
PLUMBING PERMIT APPLICATION
*ONL Y AN ORIGINAL APPLICATION SIGNED B Y A MASTER PLUMBER WILL BE A CCEPTED \
Date: 6-1 Building Permit#:_
Application is hereby made to the Building Inspector of the Village of Rye Brook N-', for the issuance of a Permit
to install Plumbing as per detailed statement described below,and in accordance with all applicable Federal,State,
County and Local Codes,at: CCU,,��II t�
p�\ 1 I • 02 d�
Address: 7 G 0 W,e 5 Ac A,- S k h Phones#:
Owner: cS U U ~ to O �� ��s �"�9dres�&Phone: �O J '
Use/Occupancy: Z-,-,h Parcel I.D.#: Se-c . _-, A/ /e /9 L e 15 Zone:
--------------------------------------------------------------------------- 35. - -!-=--a=--- -----------------------
FIXTURES &LINES ARE TO BE INSTALLED ACCORDING TO THE FOLLOWING SCHEDULE:
Water Urinals Drinking in Showers Bath Laundry Domestic Fire Sanitary Natura]/ Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
* Other:
Describe Natural /L.P. Gas Appliances-k".1 G -t -11 E ''-'Yo �x
J!
►�e w "_5 t_..-- -to ` 0-,N,A S
H.V.A.C. /Water Heaters;
LICENSED MASTER PLUMBER'S INFORMATION:
Name (please print): Gt✓k /e. eo ✓�e Phone#: 7 3e- 7J 7�
Signature: l Westchester County License#:
Company Name: L-1
Company Address: City/Tovm: Pe
State: ��L� Zip Code: e 3 Phone#: -/3�- '7ef'7,f
.. . . .. ■■ . . .. . . ■. . .. .. .. .. ... . . ... .. .. . . . . . ... . . . . . .. .. . .. . . . . ... ■ . . . .. . . .. . . . . .. ... ...
FOR OFFICE USE ONLY:
Approval Date: a 4i Approval Signature:
Plumbing Permit It: 0
Permit Fee: