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� :bc Eo-�:ig�e��n <br /> �! ��T� �� CONSTRUC'fIQN everett <br /> eVeTett PERMIT <br /> � CIiY IIAIL ]59A8fli <br /> NEPEiI,NAS�IiY610p <br /> 98}01 <br /> °`�` °"°"°'°""° BUILDING MECHANICAL PLUMBING <br /> oEVEiaer.�.[ur <br /> OWNER MAILA�DRE55 ZIP 1'HONE <br /> I ~ . :. .. . .. . <br /> t.� :�``r"`: :: ? n r �riC���'S ?j?..?7 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSL NO. <br /> GENERALCONTFl�CTOR MAILAODRE55 PHONE LICENSENO. <br /> �� � �w �� n_.': `�.'�!�'.':`..Gv <br /> MECHANICAL CONTRACTOfl MAIL AODRE55 PHONE LICENSE NO. <br /> PWh1�INGCONTf1ACTOR MAILADDRESS PHONE LICENSENO. � <br /> W <br /> m , <br /> PERMIT CLASS OF WORK � <br /> � <br /> z <br /> �BUILDING � PLUMBING �MECHANICAL F- <br /> — ❑NEW ❑ADDITION ❑ALTERATION �REPAIR � <br /> VALUATION OF WORK � <br /> 5 �M fldl ❑ULtdOL1511 ❑F[NCE ❑SIGN ❑SWIMMING POOL � <br /> Vf�l1I <br /> OESCRB[WORK q/ /l {� <br /> «Y'; 4rl? . .�. •+j�. i.v�v <br /> PFOPOSED USE <br /> MECHANICAL <br /> I TVPE OF FUEL �OIL �NAT. �LPG. �ELEC. <br /> I LEGAL UESCRIPTION OF PROPEFTV (SHOW BELOW OR ATTnCH GAS <br /> I FOUR CO�+PIE51 ���.y� <br /> �� Loi_.l_ BLOCK c:r�oF �w"'�� NO. TVPE OP E�UIPMENT FEE <br /> I AIfl COND. UNITS-H.P. EA. 5 I <br /> REFRIGERATION UNITS-H.P. EA. --�— <br /> � �OILERS-H.P. EA. � <br /> GAS FIFE�A.0 UNITS-TONNAGE EA. <br /> FORCEO AIF SVSTEMS-�.T.U. M EA. I <br /> JO� AODFESS WqLL HEATERS-E3.T.U. M <br /> �1 1:`.'�..:- <br /> �^� �° - `-�^� UNIT NEAT[RS-B.T.U. M I <br /> EVAPORATIVECOOLERS � <br /> PLUMBING CLOTNES DRYERS <br /> I <br /> VENTILATION FAN <br /> RANGEHOOO � <br /> NO. TYPE OF FIXTURE OR ITEM FEE A�R HANDIING UNIT- C.F.M. <br /> WATER CLOSFT �TOILET) g INCINERATOR � , <br /> B4THTV8 <br /> LAVATORV�WASHBASIN) � <br /> SHOWEfl <br /> KITCHEN S�NK& DISP. SUB TOTAL 5 � <br /> DISHW�ISHER PERMIT 5 <br /> LAUNDRY TRAV TOTAL FEE 5 I <br /> CLOTHES WASHEH THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC� <br /> _ WAfER HEATER , TION AVTHORIZGD I$ NOT COMMENCE� WITHIN 120 DAVS, OR IF <br /> I UFINAL _ _ CONSTRUCTION OR WORK IS SUSPEN�ED OR A�ANDONED fOR A <br /> I DRINKING FO��RvTAW PERIOD OF 120 OAVS AT ANY TIME AFTER WORK IS COMMENCED. <br /> FLOOfl-SINK Ofl ORAW �- I HERE�V CERTIFV T�iAT I HAVE RFqD AND EXAMWED THIS AP� <br /> I VACUUM E3REAKERS PLICATION ANO KNOW TME SAME TJ 6E TRUE AND CORRECT. ALL <br /> PfiOVISIONS OF LAWS AND ORDIIJANCES GOVERNING THIS TYPE <br /> ROOF OftAINS-RAINLEA�ERS OF WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED IIEREIN <br /> SINK ISERVICE-BAR, ETC.) OR NOT, THE GViANTING OF A PE,^,fvi'T �OES NOT PRESUME TO <br /> GIVE nVTHORITV TO VIOLATE OR CF,NCEL THE PROVISIDNS OF <br /> ANY OTHEFi STATE OR LOCAI. LAW RE.GULATING CONSTRUCTION <br /> ' OR THE PERFOqMANCL OF COPISTRUCTION. <br /> SUB TOTAL <br /> � PERMIT > --+ <br /> �I TOTAI FEE 5 ___L_ n�'� <br /> x �• <br /> SIGNATUREOFCONTRACTORORAUTH.AGENI' DATE <br /> SIDE Vl�qD SBTBltCK FTftECT SETO/lCK REAR 1'11RO5ET[3ACK PLAN CHECK NUM14�ER PLAN CHECK FEE <br /> FEc RECEIPT NO. <br /> � USE ZONE LOT AflEA VACANT SITL <br /> i ❑YES ❑No FEES VALUATION FEE <br /> TVPE OF CONST. OCCUPANCV GROVP NO.OF DWELLING <br /> UNITS � <br /> � <br /> ISIZE OF HLDG. NO. OF STORIES MA%.00Q LOAO BUILDING 5 ����� , � <br /> I PLUMBING I <br /> FIFE20NE �ASEMENT FIRESPqINKLEF: I <br /> ' RfQUIFED � <br /> I ❑VES ❑NO ��ECHANICAL � <br /> SPECIAL CONDITIONS: pTHER � <br /> I <br /> T <br /> i — PENELTY SEC. 303(al I <br /> TOTAL C I <br /> I _ � <br /> PERMIT VALIDATION <br /> 'I WHEN PqO�[RLV V/1LIC�ATED (IN THISSPACE) THIS IS VOUR PERMIT <br /> APPLICATIOYACCEVTE�OY' P�ANSCHECNEDOY'. �PPqOVEDF011155UN:C[OT. <br /> I '� V• <br /> � n � <br />