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i 1ho Evefgrcen � <br /> ��rY �� CONSTRUCTION everett <br /> everett PERI��T <br /> �,:. ,,�,� ,:.;e�o, <br /> LPFFCIT NFY�IhOipH <br /> 96]01 <br /> °�°, °`�°�°�"' gUILDING MECHANICAL PLUMBING <br /> 0[VtIOhA[M1 <br /> OWNEfi /� MAIL ADURE55 ZIP PMONL yyy <br /> • ��1J =� I�� ��IJ-u ��� <br /> ARCHITECTORDESIGNER MAILADORE55 pMONE LICENSENO. <br /> GENEyR�A�L CON�+�TR��AC.T�OR MAIL ADDNE55 PHONE LICENSE NO. <br /> JR�=% �.�/g.-lk- • <br /> MECHANICALCOIRTFACTOR MAILADDRE55 PHONE LICENSENO. <br /> PLUMBING CONTRACTOR MAIL ADOHE55 PMONE LICENSE NO. a <br /> W <br /> m <br /> PEFMIT CLASS OF WORK � <br /> Z <br /> �BUILDING ❑PLVMBING ❑MECMANICAL F' <br /> �_]NEW ❑ADDITION ❑ALTERATION �EPAIR � <br /> VALVATION OF WORK � <br /> S � ❑OCMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL a <br /> �ESCRIB@ WONK <br /> rt�cn c�ar �:� o-a.a f 16 9 5 <br /> PROPOSED USE MEChANICAL <br /> LEGAL DESCRIPTION OF PROPERTV (SHOW BELOW OH ATTACH TY�E OF FUEI �OIL ❑GAS ❑LPG. �ELEC. <br /> FOUR COPIES) <br /> LO7 BLocK_OF NO. TVPEOFEDUIPMEN7 FEE <br /> AIR CONP.liNITS-H.R EA. S � <br /> HEFRiI".[FATION UNITS-M.P. EA. <br /> BOILr q5-H.P. EA. 1 <br /> GAS FIqEO A.C. UNITS-TONNAGE EA. <br /> FORCED AIR SYSTEMS-B.T.V. M EA. I <br /> JOB ADDRE55 �(� fYc �M WALL HEATEP.S-B.T.U. M <br /> .7v✓L �"�Tc:l VNIT {1EATERS-B.T.U. M I <br /> LVi.PORATIVE COOLERS <br /> PLUMBING aorHes onveas i <br /> VENTILATION FAN <br /> RaNGEHCOD I <br /> NO. IYPF OF FIXTUNE OA ITEM FEE �+�R Hl1NOLING VNIT- C.F.M. <br /> WATER CLOSF.T ITOILETI y �NCINEqATOR I <br /> [iFTNTUB � I I <br /> LAVnTORv(WASH BASIN� <br /> --�� YIVV:Lfi ... <br /> Y.IICHfN51NKft016P. SUBTOTAL S � � <br /> DISVIWASNER _� PERMIT S _ <br /> LP.UNDIiY 1qqV TOTAL FEE $ � <br /> CLOTHES Wl+SHEP _ TNIS VERMIT BECOMES NULL AND VOID If LYORK OR COIISTRUC� <br /> WATF.R 11EA1ER TION AUTI/ORIZEO IS NOT COMMENCED WITHIN 120 �AVS, Ofl IF <br /> VRINf�L CONSTRUCTION OF WORK IS SUSPENDED OA AAANDf1NED 1°09 A <br /> DRINKING FOUNTAIN PEftIOD OF 120 D4Y5 AT ANV TIME AFtEA WORK IS COMMENCED. <br /> �LODA-S�NK OR ORAIN � MEREUY CEFTIFV THAT I HFVE REAn AND E%AMIN[D THIS AP� <br /> VACUUM BREAKERS PLICATION AND KNOW TNE SAME TO RE TRUE AND CORRECT. l�Ll <br /> AOOF DRAINS-FlAINLEADERS PAOVISIONS OF LAWS ANO ORDIN�NCES GOVEANING THI.^, TVPE <br /> OF WORK WILL BE COMPLIEU WITH WHETMER SPECIFI[D HEFEIN <br /> SINK ISERVICE-[iAN, ETC.) OF NOT, iHE GRANTING OF A PEfiM1T DDES NOT PRESUM[ iO <br /> GIVE AUTHOFlITV TO ViOLATE OR CANCEL TME PROVISIONS CF <br /> ANV OTH[R STAiE 0Ii LOC/1L I.AW REGULATING CON:TRUCTION <br /> OP TNE PERFORMANCE OF CONSTRUCTION. <br /> SUBTOTAL � <br /> PERMIT $ —� <br /> TOTAL FEE S� <br /> x <br /> SIGfVATUHEOFCONTRACTORORAUTH.AGENT OATE <br /> SIDEYnRD3ET�ACK STREETSETOACY. REAiiYAflOSETOPC PLANCHF.CKNUM9ER PLANCHECKFEE <br /> fEE RECEIPTNO. <br /> USE 20NE LOT AREq VACANT SITE <br /> ❑VES ❑NO FEES VALUATION FEE <br /> TVPF. OF CONST. OCCUPANCV�ROVP UNiOs OWELLING � <br /> $12E OF ULDG. NO.OF STORIES MAX.00C. LOAO BUILOINO S �w1/�NY � r++ <br /> —1 <br /> PLUMBING � <br /> 1'IHE20NE BAS[MENT FIHESPRINKLEflS <br /> REOUIRED � <br /> ❑VES ❑NO MECHAfIICAL I <br /> SPECL'1L CONDITIONS: OT!IER � <br /> I <br /> PENELTV SEC.30JIa1 � <br /> _ � <br /> — TOTAL <br /> PERMIT VALIDATION <br /> _ WNEN PROPERL�'VALIDATED UN THIS SPAC@I TH15 15 VOUR P@RMR <br /> /,rplit.nilONp6[PICOBY'. PLAHSLHECkC09M: APPPOVWfOPI55�lANCFBY. <br /> � �� <br /> � <br />