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��yE aRou� BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
93 8 KING STREET RYE BROOK NY 10573
(914) 939-0668 FAx(914)939-5801
9902 www.ryebrook.org
PLUMBING PERMIT APPLICATION
*MUST BE FILED BYA LICENSED MASTER PLUMBER ONLY*
Date: 1.27 A q t�lwrr,n�r� Building Permit#:
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Fee: �F)PCI \ 088 ApproN,al Signature:Tivance
AR 3 0 2009
—
Application is hereby made to the Building Inspector of the Village of Rye Brook NY,for 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 the following location:
Address: gf D 0 W Pf �G/�e SJP/L "�V Phone#:
Owner: g P t_j Address &Phone: •7o 0
Use/Occupancy: Co n n . Parcel I.D.#: / 3J� • �� - Zone:
LICENSED MASTER PLUMBER'S INFORMATION:
Name(please print).
0 Phone#: fl510fl 41y//771V_
Signature: Westchester County License#: 3�b
Company Name: T tv.`���H✓���a,�" 1-k
Company Address: o�1 Joe/14/pk dye, City/Town: LA<ZCl�` ,+>o,✓%
State: Zip Code: l0-1-1 S, Phone#:
..................................... 0............................ ■.................■■
FIXTURES &LINES ARE TO BE INSTALLED ACCORDING TO THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
Basement
1 st Floor
2nd Floor
Outside 1 �! /� /
*Other: &441.4ce_ C7, flASi NS y�/��/Z y 410,-) Y �b �saS'�✓1
Detailed Description of Appliances etc...:
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