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!hc Evergrcrn <br />Qi'V OF= <br />everett <br />CI�YNALL 1598885 <br />P: CPCIt.'9A911HGiIli1 <br />9A]I11 <br />GtCt 0� CpLLSIOpItY <br />u[vu.ocuExr <br />NER <br />♦I'::': ��3`.i:it.i:_T <br />;':111.,.., ^ortez <br />GONSTRUCTION <br />PERMI�" <br />BUILDING MECHANICAL <br />MAIL ADDRESS ZIP <br />_ �':i .:L:'s+: �'.���`:1 <br />�t. 4, '.3CY ;��� �TiO}ip'3�"7'.; <br />F'LUMBING <br />PHONE <br />��:.�.'•���3 <br />75�s <br />❑BUILDING �PWMBING �MECHANICAL <br />❑NEW ❑ADDITION ❑ALl'EflAT1UN QF[P41R <br />/AIUATION OF WOflK <br />5 y ._,�.r�,�� ❑OEMOLISH ❑FENCE ❑SIGN ❑SWIMMINGPOOL <br />)ESCRIBE WORK - <br />s�.C('.T;1�'� :il�.C�C^,:i� L'I:iij.ti;�'r •:':.i�:(i�OqP.� x:til:tud.�'.�nr:-repair.-r:.gl.ac� :7•',.; <br />�aoaosEo use <br />CsiIx : rn�r.a^+ MECHANICAL <br />JOB ADDRESS <br />,'�?�:: Bla;. ^tr::et <br />PLUMBING <br />I CLOTHES WASHER _ <br />'�, WATER HEATEfl <br />UIiINAL <br />I DRINKING f-OUNTAIN <br />f1.00R-SINK OR GRAIN <br />VACUUM �PF/�KERS <br />FOOF ORAINS-RAINLEAC <br />SINK ISEIiVICE-BAR, ETC <br />I <br />SU[ <br />PEF <br />TOl <br />I <br />� <br />I SIDE Vl�RDSETE7ACK STREET <br />SPECIAL CU�JUi 11ON5�. <br />everett <br />1. r�; �'"% i <br />z <br />w <br />m <br />� <br />7 <br />Z <br />F <br />� <br />� <br />W <br />a <br />2874 <br />wwoaaTTnc�i 'r'"�,urrut� �oi� ❑GAS. ❑LPG. �ELEC. <br />d2113 CO� II 18C NO. TVPE OF E�UIPMENT FEE <br />AIR COND. UNITS-H.P. EA. 5 I <br />REFRIGERATION UNITS-H.P.EA. � <br />DOILEflS��-H.P. EA. � <br />GAS FIftED A.C. UNITS-TONNAGE EA. _J <br />FORCEOl�IR SYSTEMS-�.T.U. M EA. I <br />WAL� HEATERS-U.T.V. A1 <br />UNIT HEATEqS-B.T.V. M I <br />EVAPORATIVECOOLERS —� <br />CLOTHESORYERS � <br />VENTIIATIpN FAN <br />RANGEHOOD I <br />F E �+IF HANDLING UNIT- C.F.M. —� <br />e . , INGNEFATOq I <br />REAFi <br />❑VES ❑NO <br />� SUBTOTAL $I � <br />PERMIT $� T <br />TOiAL FEE 5 I <br />I <br />TIi15 VERMIT �ECOMES NULL AND VOIO !F WOflK OR CONSTRUC� <br />TION AUTHORIZED IS NOT COMh1ENCL0 WITHIN 110 DAVS, OR IF <br />CONSTRUCTION OF WORK IS SUSP[NDED OR ABANDONED FOR A <br />PEFIOO OF 120 DAVS AT ANY TI�1E AfTER WOF:K IS COMh1ENCE0. <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED TNIS AP� <br />PLICATION AN� KNOW THE SA�dE TO �E TRUE AND COPRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL �E COAIPLIEO WITH WHETHLR SPECIFIED HEfiEIN <br />OR NOT, TNE GRANTING OF A PEftM1T DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL T11E PROVISIONS OF <br />AIJV OTH[R STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OF iHE PERFORMANCE OF CONSTFUCTION. <br />�� i c'• =�� � 7/13/77 <br />x �� ��-,.;,,_, "� j�,:=��lLi. <br />1 <br />SIGN�REOFCONTRACTORORAVTH.AGENT DATE <br />'LAN CHECK NUh4[i[.. PLAN CHECK FEE <br />FEE FECEIPT NO. <br />FEES VALUATION FEE <br />— T <br />- � a�9 0�� �� .-�-- <br />MA%.00C. LOAD AUILDING S / ' • '� "` <br />PLUM�ING �'�� �'�� <br />PIRESPRINKLEFS I <br />Rf�UIREO I <br />❑VES ❑NO MECHANICAL � <br />GfHER � <br />I _ <br />PENELTY SEC.3031a1 I <br />TOTAL �—�,T'— <br />1 <br />PERMIT VALIDATION <br />WI�IGN PROPEIiLV V�ILIDM[D lIN THIS SPnCE) T1P5 IS YOUR PER�11T <br />