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!hc Fr,vyn!en <br />everett <br />[RV IU�LI 1S9dfi}.5 <br />EVFPE11.1Yq5NINfi1Cl1 <br />9A]Ci <br />„E�, ��, ��,,,,.,,�v�,Y gUILDING <br />o[vRavnani <br />CONSTRUCTiON <br />PERMIT <br />fviECHANICAL PLUMBING <br />ee�ereri <br />O♦WN[R /� MAILAOD�{R�,E�55�� ZIP PHONE <br />J� �.r11'1 �r�7 uVl-WV �'l� <br />ARCHITECT OF DESIGNEfl �1AIL ADDRE55 PHONE LICENSE NO. <br />L�7-?:� <br />GENERAL WNTR�CTOF MAIL ADORESS PHONE LIC[NSE NO. <br />iM_i�. ��a':'S:�O L- ?�h ��.� <br />MECHANICAL CO�lTRACTOli MAIL ADUIiE55 PHONE LI(;ENSE NO. <br />PLUMOIhS CONTRACTOR MAIL AODRE55 PHONE LICENSE NO. � <br />W <br />m <br />� <br />PERMIT CLA55OF WORk � <br />z <br />��UILDING �PLUM9ING �MECH�INICAL F- <br />❑NEW ❑ADDITION ❑AI.TERFTION ❑REPAIR � <br />VALUATION OF WORK $ � <br />[]DGMOLI511 ❑FENCE ❑SIGN ❑SWIMMWG POOL � <br />DESCRIpC WORK <br />�al� �3,�s, a..� ,m.� � a� �'r rro�to� 12 4;3 <br />PROPOSED USE MECFIA�VICAL <br />TV�'LO�FUEL �OIL �NnT. ��LPG. �ELEC. <br />LLGAL OESCRIPTION OF PRUPERTV ISHOW �ELOW OR ATTACH �n`. <br />FOUqCogi _1 G�J i�419�� NO. TVPEOFE�UIPMENT F8C <br />L T�BLOCK_OF ----- <br />/11R CO ). UNITS -H.P. EA. 5 I <br />REFHIGCliATION UNITS� H.P. EA. <br />-_ pORERS H.P. [A. I <br />GA$ FIRED A.C. UNITS-TONNAGE EA. <br />FORCED AIR SVSTEMS--B.T.V. M[A. I <br />100 ADDRE55 WALL H[ATERS-A.T.U. M <br />�� �f� UNIT HGHTERS-B.T.I.. M I <br />EVAPORATIVECOOIERS <br />PLUMBING CLOTHESDRVERS i <br />V ENTILATION FAN <br />RANGEHOOD I <br />NO. TVPE OF FIXTURE OR ITEM FEE ni� HAP.DUNG UNIT- GF.M. � <br />W/1iEFCLOSETITORETI S —�- IiJCWERATOR I <br />OATFITV[1 <br />LAVATOFYIWASHBASINI I <br />SHOWEfI -�— <br />KIT(.H�NSINKROISP. �— SUBTOTAL '> � <br />_ DISHWl�SHEFi I PEPMIT 5 ' <br />__ LAUNDRV TViAY TOTAL FEE S� I <br />CLOTHHS WASHFF 7ti15 PER411T [3ECOMES NULL AND VOIU IF WCAK OR CONSTFUG <br />WATEfi HEATER TION AUTHORI2ED IS NOT COMMENCED WITH N 120 DAVS, Ofl IP <br />URINAL CONSTRUCTION OR WORK IS SUSPENIJEO Oii A9ANDONED FOP F <br />DFINKING POUNTAIN P[RIOU OF 1.0 UAVS AT ANl TIM@ APTER WOFK IS COMMENCEI). <br />fLOOP-SINY. OR DRAIN I HEHc13V CbRTIFV THAT I NAVE f15AD ANO GXAM1IINED 1NI5 AP� <br />VACUUM !3H[AKER� FLICl�TION /�ND KNOPJ THE SAAt@ TC UE TRVG AND CORRECT. l�LL <br />ROOF ORAINS-RAINLEAOEiiS I P�nVISIpiVS OF LAWS AND OFDINANC[5 GUVERNING THIS TYPE <br />Of- IVOHI: 141LL UE COMPLILD lNllll WHETHER SPECIFI[D NERLIN <br />SINKISERVICE-DAR, ETC.) OR MOT. THE GRAP�TING OF A VER111T OOES NOT PRESUME TO <br />GIVG ,:UTHORITV TO VIOLnTE OR CnNC[L THE PROVISIONS Of <br />I�NY CTHCR SL1TB JR LOCAL LAW HECULA IING CONSTRUCTION <br />OR 7IIE PCHlORM11A�CE OF CONSTf1UCTION. <br />SUB TOTAL <br />PEqMII 5 —i-- <br />TOTAL FEE $ � ^����� <br />X <br />SIGNAT4R[OFGONTIInCTORORAUTH.I�GBNT DATE <br />SIOEYA(iDSET6l�CK STREE�SET�l1CK flEARYAROSETI3ACKPLANCHECKNUMAEfi PLANCHECKFEE <br />FEE RECEIPT NO. <br />US@ZONE LOTAREA VACANTSITE <br />❑vES ❑No FEES VALUATION FEE <br />7VPE OF CONST. OCCUPANCY GROUP UNIT�S DWELLING ' <br />SI2G OF BLDG. NO.OF SrpRl[5 MA%.00C. LOAO QUILD�NG 5 �� <br />PIUMBING � <br />FIflEZONE 16.15[M1iLNI q�pUIREIDKLERS i <br />❑YES ❑NO MECHANICAL I <br />SPLCIAL CONDITIONS' OTHEfl � <br />--.— —_-_ I <br />._-_____- — - PENELTY SEC.3031a1 � <br />_ _"" TOTAI. � <br />I <br />PERMIT VALIDATION <br />_ lVN[N PROP[RLV l�AUOATED 11N THISSPACE) THIS IS VOUR PfflM1T <br />n'lICn11p•1nLft�ilftliv PLe.4'OIfCKfOfiv APpflOVCOFOIiqUANC[LY <br />C5� <br />� <br />