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� <br /> I <br />� ,;,,, �.��,,,,...•„ <br /> � <�" ,, CONSTRUCTfON everett <br />� everett PERMIT <br /> ���. �a.� ,..�,r. <br /> � ���aE� ��,,,�.� � <br /> �d�„� <br /> """ °"°"'"'-" ' gUILDING MECHANICAL PLUMBING <br />< <,�.�t,��,����. <br /> I �WNER MAILAODRESS ZIP GHONE <br /> Jonal� -'. t*ylly':a'.a�-,:aR"23 Malby �:.:. ".oc��?irFvill� �An72 385-'lfl;.'" 9ya- 77 <br /> ARCHITECT OR DESIGNEH MAIL ADORESS PHON` LKENSE NO. <br /> GENERAL CONTRACTOR MqIL AODRESS � PH)NE L�CENSE NO. <br /> IMECHANIC�IL CONTRACTOR MAIL A��RESS PHONE LICENSE NO. <br /> I <br /> � PLUMBING CONTFACTOP MAII qDDRESS PHONE LICENSE NO. � <br /> I W <br /> � _ m <br /> � PPEflMIT CLASSOFWOPK � <br /> i <br /> I � <br /> ❑BUILDING �fLVMBING �MECHANICAL Z <br /> ❑NEW ❑ADOITION ❑PLTEFATIUN ❑REPAIH ~ <br /> VALUATION OF WOFK -- — — � <br /> $ �'��rj� ❑DEMOLISH ❑FENCF. ❑SIGN ❑SWIMMING POOL W <br /> DESCRI6E WORK 1 � �� ' ---' <br /> a <br /> � S�A t�C1�JYS�.RIICC �'jYL� <br /> r v <br /> � PROPOSED USE <br /> MECHANICA� <br /> � TVPEOFFUEL QOiL �NAT. �LPG. �E.EC. <br /> I LEGAL DESCfitPTION OF PROPEfiTY (Y.HOW BELOW OR ATTACH GAS <br /> POURC,p%ES� <br /> I $ LS PSQN!}TZ)' 'i.'IIZ'd �'� NO. TVPEOFEOUIPMENT FEE <br /> � LOT__ gLOCK—OF__ <br /> � AIR CON�. UMTS-�H.P. EA. § � <br /> j REFRIGERATION UNITS--Y.F. EA. <br /> I -- BOI LERS-H.P. EA. � <br /> C4S FIRED A.G VNITS-TONNAGE EA. <br /> ' FORCED AiR SVSTEMS-B.T.U. M EA. � <br /> � JOB 40 � WqLL HEATERS-B.T.U. M <br /> � °s`��:, :�;i,sn <br /> UNIT HEATERS-B.T.U. M � <br /> � PLUMBING EVAPOFATIVECOOLERS <br /> ; _ CLOTHESDRVERS � <br /> I VENTILATION FAN <br /> I RANGEHOOD � <br /> NO. NPE OF FIXTURE OR ITEM FEE A�R �qNouNG uNIT- C.F.M. <br /> iWATER CLOSET(TOILET) g �— iNCINEftATOR � � <br /> I BATHTUB <br /> i LAVATORV(Wq5H8ASIM � <br /> SHOWER <br /> K�TCHEN SINK& DISP. � <br /> f DISHWASHEP SUB TOTAL $ � � <br /> � 'LAUNDFV TRAV _ PERM�T $ ; <br /> I �CLOTHE~— S WASHER TOTAL FEE $ � I,� <br /> �WA-. ER HEATER 1HIS PERMIi BEGOMES NULL ANq VOID IP WORK OP CONSTRUG <br /> — TION AUTHORIZED IS NOT C0�5INENCED WITHIN 120 DAVS, Ofi IP �' <br /> I URINAL CONSTRUCTiON OR WORK IS SUSPENDED OP ABANDONED FOR A I <br /> � ORINKiNG POUNTAIN PERIOD OP 120 DAVS AT ANV TiME qFTER WOAK iS COMMENCED. � <br /> � F�OOR-SINK OR DRAIN. � I HEREBY CEftTIFV THAT I HAVF REAO AND E%AMWED THIS AP- I <br /> � VACUUM BREAKERS PLICATION AND KNOW THE SAME l'G BE TRUE AND CORRECT. ALL <br /> � 400F pRAiNS-qqIWIEADERS PRGVISIONS OF LAWS AND CRDINANCES GOVERNING TH�S TVPE <br /> GF WOqK WILL BE COMPLIED WITH WHETHEP SPEQFIED HEREIN <br /> S�p11S_($ER..IV �-B +— OR NOT, THE GRANTRJG OF A PEPM1UT OOES NOT PqESVME TO <br /> rx'¢s-at,x GIVE AUTHORITV TU V�OLATE OR CANCEL THE 'ROY131JN5 OF <br /> ANV OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION <br /> — OR THE PERFORMANCE OF CONSTRUCTION. <br /> SV3TOTAL <br /> PERMIT $ � <br /> � I � ____ TOTAL FEE $ /y�� / /7�/ / . �'�',,� . � <br /> i x �Ii'�-t'�/' ! l, �-C.n /�.%'I�•�q�. <br /> SIC3NATUREOFCO RnC PORAU .AGENl DATE <br /> � SIDE YARD SETBqCK �STftEET SETBACK qEAR V4RDSETBACK PLAN CHECK NUM R PLAN CHECK FEE <br /> � II FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANTSITE — <br /> GYES ❑ivo fEeS 7AWATION PEE <br /> � � TYPE OF CONST. OCCUPANCV GROUP NO.OF C�WELLING <br /> I UNITS <br /> I <br /> ISIZE OF eL�G. NO.OF STORIES MAX.00C. LOAD BUILDING $ � � <br /> I <br /> I —_ PWMBING I <br /> FIREZONE BASEMENT FIRESPftIN<LERS � <br /> �I RCQUIRED <br /> ❑VES ❑NO MECNAPJICAL � <br /> I ! <br /> SPECIP.L COf�D�TIONS�. ' <br /> _ OTHER � <br /> I <br /> — ' ---� --�� PENELTv SEC. 3D3�al I <br /> � TOTAL � � <br /> I _ . _ _ PERMIT V.QLPDATION <br /> I VV4ENVROPFRLVVALIDMEU !INTHISSPACEITHISISVOURPERMIT � <br /> I _ __ <br /> I <br /> InVPLI�(.TI��N/�(Cr�T=�9Y P'�qN$l;XECKfppM 1PPNOVEf1�OR.GGLIn`fEI1V <br /> I I � �� I <br /> I <br /> : <br /> � . . .�... _� <br />