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tAe fvergreen <br /> ��TYOF CONSTRUCTION everett <br /> ever�tt PERMIT <br /> LIiY IIALL ]:9BB65 <br /> EVENEiT.Wq511iNGTON <br /> sami <br /> °"' °"°",°,°""" BUILDING MECHANICAL PLUMBING <br /> o veiavsiexr <br /> OWNER MAIL ADDRESS ZIP PMONE <br /> F' f I7�(V <br /> ARCHITECTOflDESIGNER M4ILADDFESS PIiONE IICENSE �10. <br /> GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br /> S�� <br /> MECHANICAL CONTRACTOR MAIL AODRESS PHONE LICENSE NO. <br /> �,�,✓ '._':l i��14 A LK:�•aL1:�1J� � <br /> PLVMUING CONTRACTOR MAIL ADORESS PHONE LICENSE NO. W <br /> m <br /> PEflM1T CLASS OF WOFiK � <br /> z <br /> ❑ BUILDING � PLUMBING [�MECHANICAL . F <br /> �NEW ❑PDDITION ❑ALTERATION ❑REPI�IR � <br /> VALUATION OF WORK � <br /> 5 ❑DEMOl15H ❑FEIICE ❑SIGN ❑SWIMMING POOL a <br /> DESCRIB[WORK <br /> �.� :�-�� s$s <br /> PflOPOSED VSE <br /> MECHANICAL <br /> TVPEOFFUEL �OIL �NAT. �LPG. �ELEC. <br /> LEGAL�ESCRIPTIOM OF PROPERTY ISHOW BELOW ON ATTACiI GAS <br /> FOUR COPIE5) <br /> �O7 pLOCK_OF NO. TYPEOFE�UIPMENT FEE <br /> AIR COND. UNITS-H.P. EA. $ I <br /> REFRIGEFATION UNITS-H.P. EA. <br /> �OILERS-H.P. EA. � <br /> GAS FIRED A.C. UNITS-TONNAGE EA. <br /> FORCED AIR SVSTEMS-e.T.U. M EA. <br /> JOB AODRESS WALL HEATERS-B.T.U. M <br /> �� ��i'��� �y UNIT HEATERS-B.T.U. M I <br /> PLUMBING EVAPpqATIVECOOLERS <br /> CLOTHESDFYERS I <br /> VENTILl�TION FAN <br /> RANGEHOOD I <br /> NO. TVPE OF FIXTURE OR ITEM FEE A�A HANDLING UNIT- C.F.M. <br /> WATER CLOSET(TOILETI 5 INCINEFATOR � <br /> BATHTUB <br /> LAVATOFY�WASHBASINI I <br /> SHOWER <br /> KITCHEN SINK& DISP. __{ SU�TOTAL 5 <br /> DISNWASHER PERMIT 5 <br /> LAUNDqY TRAY TOTAL FEE 5 <br /> CLOTHES WASHEfi THIS PERMIT 6ECOMES NVLL AND VOID IF WORK OR CONSTRUC- <br /> WATER HF4TER TION AUTHORI2[D IS NOT COMMENCED WITHIN 120 OAVS, OR IF <br /> URINAL CONSTRUCTION OF WORK I: SUSPENDED OF l��ANDONED FOR A <br /> OflINKING FOVNTAIN PEFIOD OF 120 DAVS AT ANV TIME AFTER W07K IS COMMENCED. <br /> FLOOR-SINK Oq DRAIN I HEREBV CERTIFV THAT I HAVE RCAO AND eXAMINED THIS AP- <br /> VACUUM BREAKERS PLICATION AND KNOW THE SAME TO UE TRUE AND CORRECT. ALL <br /> - ---�-- PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE <br /> ROOF DRAINS-RAINLEADERS OF WORK WILL DE COMPLIED WITIi W1IETHER SPECIFIED HEREIN <br /> SIWK (SERVICE-DAR, ETC.) OR NOT, THE GNANTING OF q PERMIT �OES NOT PqESUME TO <br /> GNE AUTHOFITV TO VIO:.ATE OR CANCEL THE PfiOVISIONS OF <br /> { ANY OTHER STATE OFi LOCAL LAW REGVLATING CONSTRUCTION <br /> OR THE PEFFORMANCE OF CONSTFUCTION. <br /> SUBTOTAL <br /> PERMIT S <br /> TOTAL FEE 5 X �j�� <br /> SIGNATUREOFCONTRACTORORAUTH.AGENT �ATE <br /> SIDE VARD SETBACK STftEET SETBACK REAR VARDSET�ACK PLAN CHECK NUMBER PLAN CHECK FEL <br /> FEE fiECEIPT NO. <br /> USE 20M1E LOT AREA VACANT SITE <br /> ❑vEs ❑No FFES VALUATION FEE <br /> TVPE OF CONST. OCCUPANCV GROUP NO.OF DWEILING <br /> UNITS I <br /> 512E OF 6LDG. NO. OF STORIES MA%.00C. LOAD BUILDING 5 � <br /> I <br /> PLUMBING I <br /> FIREZONE f3A5EMENT FIRESPFINKLEFS _.. 1 <br /> REQVIRED � <br /> ❑VES ❑NO MECHANICAL •f � <br /> r <br /> SPECIAL CON�ITIONS: OTHER � <br /> 1 <br /> PENELTV SEC. 3031a1 I <br /> TOTAL � <br /> � � <br /> PERMITVALIDATION � <br /> W HEN PROPERLV VALIDATED (IN THIS SPACEI TFIIS IS VOUR PERMIT <br /> �PPLICATiON�CCEVi[ppV' Pl�NSCIIECNE08Y: AVPPOVEOFyOhI55UANCEDY�. <br /> lr C� <br /> � <br /> �Y,L'. <br />