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r <br />`"°E°"�;,,',',� . CONSTRUCTION <br />CITY f)F <br />evel�ett PERMIT <br />CIl Y HALL :!59 N]45 <br />�v=r.err,wn �ezo, COMBINATION • SUILDING • MECHANICAL • PLUMBING <br />]1'lNER AtP.IL ADDRESS 11P PHON[ <br />___ Salem, Robert W 4959 Dogwood Drive 98203 257_-atiaa <br />❑ COMBINATION <br />❑ OUILDING � PLUMQING � MECHAN�CAL <br />8��.�0 I <br />Install new furnac��e <br />HO <br />�IC <br />❑NEW ❑AODITIOPI ❑f�LT[HATION [�}RLPAIR <br />n <br />❑oenaousf� ❑FeNce ❑sicti ❑swin�miNc Pooi. <br />everett <br />MECHANICAL <br />LEGAL DESCRIPTION OF VROPERTV (SHOW 9ELOW Oq A7TACN TYPE OF ENERG V <br />FOURCOPIE51 ❑GAS ❑ELEC. <br />LO7 o�OCK—oF_ N�• TVPE OF E�UIPMENT FEE <br />AIR COND. UNITS-H.P. EA. 5 � <br />TYdCt 14 � V12W Ridge additloR �Ef-RIGERATION JNITS lI,P, EA. _---t— <br />-----tD—P.�VE�Y'L�'C��iO'� lIOILERS -H.P. EA. � <br />]_ FORCED AIR SVSTEM1tj-p.T.U. MEA. <br />JO� ADORE55 --- - � � <br />SPACE & WALL HEAT[RS - E7.T.U. T-- <br />4959 Doqwood Dr uNir r�enT�r�s.-,a.r.u. � <br />PLUMBING evnronnrive coo�eRs <br />_ CLOTIiES URYERS � <br />V[NTILAiION FAN T <br />RANGEHOOD � <br />NO. TVPE OF FIXTURE Oq ITEM FEE nIR HnNouNG UN�7- C.F.M. <br />HFlTH TU[3S 5 — <br />_ CLOTHESWASHER i — . 1 <br />DISH LNASHEHS �^/ATER HEATER <br />i <br />UHINKING FpUNTAINS � FAC. BUILT FIREPLACE R CHIMNEV j <br />FLOOH ORl�INS � GAS. SYSTEM: NO OP OUTLE�� <br />KITCIiEN SINKS R DISV_ � 5UR TOTAL 5 y^^u� <br />_ _ U/1R SINKS � PEflM1T 5 _��-0 <br />_ ROOF UHAINS - R�IN LEADERS � ro7n� FEe 5 �(�p <br />SHOWER RATHS THIS PEHM11IT 13ECOMES NULL AND VOIO IP WORK OFi C NSiiiUC <br />SERVICE SINKS TION AUTHORIZED IS NOi COMMENC[� N'ITHIN 720 DAVS, OR IF <br />SUMPS -- SEWl�GE PUMP CONS�RUCTION OR WORK IS SUSPEND@f) OH A[tANOONGD FOR l� <br />_ URINALS � PERIOO OF 120 DAYS AT 11NY TIMh AFTER WONK IS COMMENCED. <br />WATER CLOSEiS 1 � ��EIiCf1Y CEHTIFV TIIAT 1 HAVE REI�� nND E%AMINLD THIS qp <br />WATEH HEATERS �- ELECTRIC � �'LICATION ANU KNOW TFIE SAAfE TO [3E TRUE AND COfiRECT. ALL <br />WASH BASINS �'fiOVILIONS OF LAWS 11ND ORDINANCF.S GOVEPNING THIS TVPE <br />1 OF WOPK WI�L E3E COMPLI[D WIT11 WHETH[R SPECIFIEp H[REIN <br />LAUNORV TRAY$ OR NOT, THE GHANT'ING OF A PENMIT L]OLS NOT PR[SUME TO <br />� GIVL AUTIIORITY TO VIOLATE O!i CANC@L TNE PROVISIONS OF <br />— ANY OTH[R STl1TE OH LOCAL LAW fiGGULATING CONSTRVCTION <br />- —_ � OR TIIE PERFORMANCE OF CONST(iUCTIpN. <br />_ � <br />SUU TOTAL <br />PERMIT S x �D� /� n ��M^—. <br />TOTALFfE �C <br />�l�TERSERVICESI2E [3L�G,SUPPLYSIZE tiIGNATUFiEOFCONTRACTOAORAUTH.AGENi ON��— <br />'�IUE VARD SETOACK STRLE7' SET�ACK REAR VAflD5ETf1ACK PLAN CHECK NUM1II3ER PLAN CHECK FEE <br />. _ _ I FEE �R6C[IPT NO. <br />u <br />SPECIAL CON�ITIONS: <br />-,-,,.—����.���,�„ r,�„�,- <br />❑VES ❑No I FEES VALUATION FEE <br />OAU OUILOING $ <br />PLUMOING <br />LERS <br />❑NO MECHANICAL <br />OTHER <br />PENALIV SFQ707fa) <br />TOTAL <br />PERMIT VALIDATION <br />IYHINPHOPEfiLV VAI.IOATCO( <br />I <br />_L__ <br />e bo <br />sr�nc[rrrii5 i?;l� ��� <br />l <br />KOUR REGEIP7 <br />` TNANK YO U <br />' � . — <br />i <br />