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Ure Fvciyiern � <br /> ���� � �� CONSTRUCTION everett <br />� eve rett PERMIT <br />� � �,,, �a�� �,�ddb, <br /> tYtX[�I NT.1111N�II1N <br /> YBhll <br /> I <br /> °`°' °�,��,^;�o,;„, BUfLDING MECHANICAL PLUMBING <br /> OWNEH MAIL AODFESS 21P VHONE � <br /> � � � �� � � � � � <br />�� ARCHITECT OR OESIGNER MAII ADDHE55 PHONE LICENSE NO. <br /> i GENERAI CONTRACTOR MAIL ADORESS PHONE LICENSE NO. �� <br /> MECHANICAL CONTHACTOR MAR AO�RESS PHONE LICENSE NO. <br /> PWMBINGCONTRACTOR MAILA�DRESS PHONE LICENSENO. � <br /> W <br /> � � � <br /> PERMIT CLASS OF WOPk � <br /> Z <br /> �BUILDING �PLUMBING �MECHANICPL � <br /> �NEW ❑ADDITION ❑ALTERATION ❑REPAIF � <br /> VALUATION OF WOFK �L <br /> $ ❑DEMOUSH ❑FENCE ❑SIGN ❑SWIMMING POOL a <br /> DESCRIBE WORK ��^� <br /> � � �� V <br /> vaovoseo use MECHANICAL <br /> TVPEOFFUEL �OIL �NAT. �LPG. �ELEC. <br /> LEGAL DESCfliPTION OP PROPERTV (SHOW BELOW OR ATTACH GAS <br /> FOUR COPIES) � <br /> LOT a BLOCK—oF NO. . ___TVPE OF EQUIPMEN7 _ FEE <br /> AIF COND. UMT$-H.P. EA. $ I <br /> REFRIGERATION UNITS-H.P. EA. <br /> . BOILERS-H.P. EA � I <br /> GAS FIRED A.G UNITS-TONNAGE EA. <br /> FOFCED AIR$VSTEMS-B.T.U. M ER I <br /> JOB A�S� � � WALL HEATERS-B.T.U. M <br /> UNIT HEATERS-B.T.U. M I <br /> EVAPORATIVECOOLERS <br /> PLUMBING c�oTr+es oaveas i <br /> VENTILATIONFAN <br /> RANGEHOOD � I <br /> TYPE OF FIXTURE OR ITEM FEE AIR HANDLING UNIT- C.F.M <br /> WATER CLOSFT(TOILETI g INCINERATOR I <br /> GATHTUB <br /> IAVATOFVIWASH9ASIM � <br /> SHOWER <br /> KITCHENSWK& DISP. _�_ SUBTOTAL $ � <br /> DISHWASHER PERMIT $ <br /> LAUNORV TRAV TOTA� FEE $ � <br /> CLOTHES WASHER THIS PEftMIT BECOMES NULL AND VOID IF WORK OF CONSTRVC- <br /> WATER HEATER TION AUTHORIZE� 6 NOT COMMENCE� WiTHIN RO �AVS, OR IF <br /> URINA� CONSTRUCTION OR WORK iS SUSPENDED OR ABAN�ONED FOR A <br /> DRINKING FOUNTAIN + PERI00 OF 120 DAVS AT ANV TIME AFTER WORK IS COM1IMENCED. <br /> FLOOR-SWK OR DRAIN I HEREOV CEPTIFY THAT I HAVE READ AND EXAMINEO THIS AR <br /> � VACUUM BREAKERS PLICATION AND KNOW THE SAME TO BE TRUE AND CORRKT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS TYPE <br /> ROOF DRAINS-RAINLEADERS OF WORK WiLL BE COMPUEO WITH WHETHER SPECiFIED HEREIN <br /> SINK (SEPVICE-BAR,ETCJ OR NOT, THE GRANTING OF A PERMIT �OES NOT PRESUME TO <br /> GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � - /aNV OTHERSTATE OR LOCAL LAW REGULATiNG CONSTRUCTION <br /> _ OR THE PERGORMANCE OF CONSTRUCTION. <br /> SUBTOTAL <br /> PERMIT $ � <br /> TOTALFEE $ � <br /> X <br /> � SIGN(1TUREOFCONTRACTORORAUTH.AGENT DATE <br /> SIDE YARD SET6ACK STREET SETBACK REAF VARDSET6AC PLAN CHECK NUM9ER PLAN CHECK FEE <br /> � . Aws iir � FEE IRECEIPTNO. <br /> iV�• iM1f• <br /> ySf�ZONE LOTAREA VACANTSITE <br /> �� �vES ❑NO FEE$ VALUATION FEE <br /> TV�OF CONST. OCCUGANCV GROUP UO.IOS DWELLING � <br /> S � <br /> SIZE OF BLDG- NO. OF STORIES MAX.00Q LOAD BU�LDiNG 3 �� � <br /> PWMBING <br /> FIRf�ONE BASEf�NT FiRESPRINK3LERS __.- � <br /> � j� R O�ESED [JNO MECHANICAL � � <br /> SPECIAL CONDITiONS'� pTHER � � <br /> 1 <br /> _ -- _ �- I <br /> PENELTV SEC. 3U31a) � <br /> TOTAL � <br /> PERMIT VALIDPTION <br /> ..�`�PqOPEF _Y VALIOATED (IN THISSPACEI TH1515 VOUR vERMIT <br /> nvpllf.PiIONPGCEPTEOBV PL4NSCHELKEOflY AVVpOVEOFpRIS5U�INCEBv <br /> �a �� �� � i <br />