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the fvergre<�n � <br /> =�TY�F COI�STkUCTION everett <br /> ti verett RERMIY <br /> CiiY IIqLL I599BB5 <br /> [VEHfiC Lti4411MGi0H <br /> 9B)01 <br /> °"' °oE E`�o;„E'r BUILDING MECHANICAL PLUMBING <br /> OWNER MAIL ADDRESS ZIf' �j�+ i�'�HyO!.yNE � �y�! <br /> i�,�,�..ii "'.''�{''l^'.'A^ 7T'� ,y�'•rr:..._. �.� .7l�.�c/'J.7 �CJ:���(V <br /> AR:;HITECT OR OESIGNEfl MAIL AODflESS PHONE LICENSE NO. <br /> GENERAL CONTflACTOR MAIL ADDFESS PHONE LICENSE NO. <br /> �� <br /> MECNANICAL CONTRACTOq MAIL AOORE55 PHONE LICENSE NO. <br /> P�l1MBING C�ONTflACTOF MAIL ADDR@SS PHONE UCENSE NO. � <br /> ,.`T�r•T< W <br /> . m <br /> PEftM�T CLASS OF WORK � <br /> L z <br /> � '[JBUILOING �PLUMDING ❑MEGHANICAL F– <br /> ❑NEW ❑AODITION �ALTEflATION ❑REPAIR � <br /> VALUATION OF WOflK � <br /> 5 ,�� ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL � <br /> DESCFIBE WOFK <br /> A+�" �x 26 'CC"3 5Z?�r"F t:t+. ,,.� �,Jr 3 2 <br /> PROf QSED USE MECHANICAL <br /> LEGAL�ESCRIPTION OF PROPERTV (SHOW�ELOW OF ATTACH TVPE OF FUEL �OIL �GAns, �LPG. �ELEC. <br /> FCUR COPIESI <br /> L(JT BLOCK_oF Na� TYPEOFEQUIPMENT FEE <br /> Alq CON�. UNITS-HP. EF. 5 I <br /> REFRIGERATION UNITS-H.P. EA. <br /> �OILERS-H.P. EA. � <br /> GAS FIRE�A.C.U�!ITS-TONNAGE EA. <br /> FORCED Alp SYSTEMS-B.T.U. M EA. I <br /> JOB ADDRESS �_J� WALI HEATERS-B.T.V. M <br /> 7+ '�^ �r,� �`£� UNITHEATERS-B.T.U. M � <br /> EVAPORATIVECOOLERS <br /> PLUMBING CLOTHES DRV:RS i <br /> � VENTILATION FAN <br /> RANGEHOOD I <br /> TYPE OF FIX7URE OR ITEM FEE A�R HFNDLING UNIT– Qf-.M. _ <br /> WATEH CLOSET ITOILETI 5 �NCINEFATOfi � <br /> BATHTU6 —T— <br /> —._ � <br /> LA`JATORV(WASH BASIN) I <br /> SHOWER <br /> KITCHENSI�:K& �ISP. SUBTOTAL 5 <br /> 1 <br /> DISHWA,^,I.ER PERMIT 5 <br /> LAUNDRY TpAY TOTAI FEE S � <br /> CLOTHES WASHER THIS PERMIT �ECOMES NULL AND VOI� IF NOqK OR CONSTRUC- <br /> WATEfi HEATEH _ TION AUTHOR2ED IS NOT COM�tENCED WI�'HIN 120 DAVS, OR If <br /> URINAL CONSTRUCTION OR WOflK IS SlISPENDED C.a ABANDONED FOft A <br /> ❑RII9KING FOUNTAIN PEFIOD OF 120 OAYS AT ANV l'IME AFTEP'vVORK IS COMMENCED. <br /> FLOO�–SINK OR �ftAW � HEREBV CERTIFY THAT I HAVE READ ANO EXAMINEO THIS AP- <br /> VACUUM �fiEAKERS — PLICATION AN� KNOW THE SAME TO�E TRUE AND CORRECT. ALL <br /> ROOF ORAINS–Ri�INLEP�ERS — P�OVISIONS OF LAWS AND ORUINANCES GOVERNING THIS TYPE <br /> _ OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> SINK (SERVICE–BAR, ETC.� OR NOT, THE GRANTING OF A PERMIT �OES NOT PqESUME TO <br /> GIVE AUTIiORITV TO VIOLATE Ofl CANCEL THE PROVISIONS OF <br /> �INY OTIIER STATE OR LOCAI LGW REGULATING CONSTRUCTION <br /> OR THE PERFOflMANCE OF CONST(iUCTION. <br /> SUBTOTAL <br /> PERMIT 5 <br /> TOTALFEE 5 ��[r�/.�( <br /> X +�^! �71� <br /> SIGNATUREOFCONTRACTOFORAUTH.AGENT DATE <br /> SIDF. VARDSETOACK STREETSETOACK REAFVA�DSETBACKPLANCH[CKNUMBER PLANGHECKFEE <br /> 7�� FEE U� RECE�j'�� <br /> USEZONE LOTAREA VACANTSITE jJ <br /> ❑vE5 ❑No FEES VALUATIGN FEE <br /> TYPE OF CONST. 7CCUPANCV GFOUP NO.OF DWELLING <br /> UNITS � <br /> . SIZE OF OLDG. NO. OF STORIES MAX.OCG LOAO BUILOING 5 ,.7 1tiF+v JG �SO <br /> _ PLUM6ING � � <br /> FIREZONE DASEMENT FIRESPRINKLERS <br /> R QyESE� �N� MECHANICAL j <br /> SPECIALCONDITIONS: OTHER � <br /> — I <br /> -- - � . PENELTV SEC.:7071�1 I <br /> TOTAL <br /> PEFMIT VNLIDA710N <br /> WH[N PqOPEFl�Y VALIDATED(IN iHIS5P�10E)THI515 VOUR PERMIT <br /> l.PPLiCAiiOtl4tt[PIEI�fIT� FIR�ISCNECKEpBY'. APPPOVEOFOq155OANCEOY�. <br /> �.". C• <br /> __ a <br />