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i - -- - I <br /> inc �ve„u�,:�„ <br /> _�,� �� COIVSTRUCTIOM everett <br /> everctt PERM6T <br /> LILY IIALI 25989AS <br /> EVEPELi,YIqSItlNGL011 <br /> � OFPI.OF C01.II.IUN�1P � <br /> ; �E„E,op,.,E,,, BUILDING MECHi-,NICAL PLUMBING <br /> OWNEF MAIL ADDRE55 ZIP PHONE <br /> LesCar Lr. ;;c�aas 13�:; �.���c�ar;�- i•;�3 �, ':%--27?1 I17'1-7i <br /> ARCHITECT Oq OESIGNER MAIL ADORESS PHONE LICENSE NO. <br /> GENEFALCONTRACTOR MAIIADORESS PiIONE LICENSENO. <br /> IMECHANICAL CONTRACTOR MAIL ADDflE55 PHONE LICENSE NO. <br /> PLUMBIN(U CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. � . <br /> W <br /> m <br /> PERAIIT CLA55 OF 6VORK � <br /> � <br /> ❑ �UILOING � PWMBING �MECHANICAL �- <br /> ❑NEW ❑ADDITION ❑ALTEFATION ❑REPAIft � <br /> VALUATION OF WOftK � <br /> S j��}� �� ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMINGPDOL a <br /> DESCRIBE WORK a (�[� <br /> Y@j77.3CC :7].1.10 � `tO;lr i�47:}".:Z�2�'3 .5:::�. ��r!•�:2C�dL'it7•.: � (1L ��.3Y-?i:�Zl; �J .74 <br /> PRONOSED USE <br /> CaS-;"�JTti MECHANICAL <br /> TVPEOFFUEL �OIL �NAT. ��PG. �ELFC. <br /> LEGAL DESCRIPTION OF PROPERTY (SNOW BELOW OR ATTACH GAS <br /> F�IUR��qr`51�3 Z.,i!� Ff)il�tE.'!3C)Ctl :'tSGf:. NO. TYPE OF EQUIPMENT FEE <br /> y 1 <br /> LOT BLOCK_OF_ q�ftCOND. UNITS-H.P. EA. 5 I <br /> REFRIGEflATION UNITS- H.P. EA. <br /> �OILERS-H.P. EA. � <br /> GAS FIRED A.C. UNITS-TONNAGE EA. <br /> FOftCED AIF SYSTEMS-B.T.U. M EA. I <br /> JOB ADp�3ESS�� � WALL HEATERS-B.T.U. M _ <br /> 1 JwJ 'J��I�.. �Y�, <br /> UNIT HE�1TEft5-r3.T.U. M I <br /> PLUMBING [Vl�VORATIVE COOLERS _ <br /> CLOTHESDRVERS I <br /> VENTILATION FAN —� <br /> RANGEHOOD I <br /> NO. TyPE OF FIXTURE OR ITEM FEE _ Alft Hl�NOLING UNIT- C.F,ry7, � , <br /> WATER CLOSET(TOILET) 5 INCINERATOR � <br /> �ATHTV9 <br /> LAVATORY (WASH BASIN) I <br /> SHOWER <br /> KITCHEN SINK& OISP. SUB TOTAL 5 � <br /> UISHWASH[R PERMIT 5 <br /> LAUNDFV TRAV TOTALFEE 5 I <br /> CLOTHES WASHEF THIS PERMIT BECOMES NVLL AND VOID IF WORK OR CONSTRUG <br /> WATEH HEATFR TION AUTHORIZF.D IS NOT COMMENCEO WITHIN 120 DAVS, OF IF <br /> I _ URINAL _ - CONSTRUCTION OF WORK IS SUSPENDED OR ABANDONED FOH A <br /> ` DRINKING FOUNTAIN PEFIOD OF 120 DAYS !�T AflV TIME AFTER WORK IS COMMENGED. <br /> � — FLOOF-SINK OR DRAIN 1 HERE6V CERTIFV THAT I HAVE READ ANO EXAA'dNED THIS AP� <br /> �'PCUUM OREAY.EPS �— PLICATION AND KNOW THE SAME TO BE TFUE ANC COflRECT.ALL <br /> ROOF DRAINS-RAINLEADEFS PROVISIONS OF LAWS AND OR[]INANCES GOVERNING THIS TVPF <br /> I --- �_ OF WOliK WILL BE COAAPLIEO WITH WNETNER SPECIFIED HEREIN I <br /> SINK (SEPVICE-OAft, ETCJ Of. NOT, THE GRANTING OF A PEPM1fIT �OES NOT PqESUfdE TO <br /> GIVE AUTHORITV TO VIOLATE OR CANCEI. THE PROVISIONS OF <br /> I ANV OTNER STATE OR LOCAL LAW REGULATING CONSTFiUCTION <br /> I OR THE PEftFOFMANCE OF CONSTRUC"ION. <br /> SUB TOTAL �_ <br /> PERMIT 5 <br /> IU7'ALFEE 5 ^�3�71 <br /> 'I xIGNATUREOFCONTRACTOFiORAVTH.AGENT DAlS <br /> SIDE VAfl�SET6ACK STRGET SET�ACK PEAR VAROSET�ACK PLAN CHECK NUM6EF PLAN CHECK FEE <br /> FEE ftECE1PT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> ❑VES ❑��o FEES VALUATION FEE <br /> I TVPE OF CONST. OCCUPANCY GROUP UNITS OWELIING <br /> I �— <br /> SIZEOFOLDG. NO.OFSTORIES MAX.UCQLOAD eVILDING 5 `��1'�� 7 ���^ <br /> PLUMBING � <br /> PIRE20NE RASEMENT FIFESPqINKLERS _ � <br /> ftCaUIHED I <br /> ❑VES ❑NO MECHANICAL � <br /> I <br /> SPiCfALCON�ITIONS'. OTHER � , <br /> PENELTY SEC.3091a) I � <br /> TOTAL �� ��'^ <br /> I <br /> PERMIT VALIDATION <br /> WHEN PROPERLV VALI�MED (IN THISSPl10E) THIS IS VOUR PERMIT <br /> APRICATIOW�LCEPTEO�Y: PLANSCHECNEOOM: �P�FOVE�FOA65UPNCEBY. <br /> I � i ,:., <br />