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everett <br />LePLUMBING <br />OWNER MAIL ADDRESS ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />ER <br />IIW47 <br />2 <br />VJ <br />G] <br />Z <br />~ <br />MEC�HA�NI CNA LNG ONTq CTOR MAIL ADORERS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />BUILDING []PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />❑NEW ADDITION ❑ALTERATION ❑REPAIR <br />_ <br />VALUATION OF WORK <br />f` M <br />❑DEMOLISH ❑FENCE ❑SIGN [:]SWIMMING POOL <br />D:W <br />— CL <br />DESCRIBE WORK <br />Aftt ft 2 t4 poRR4 <br />22(� <br />o <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL NAS, LPG. ELEC. <br />_ <br />NO. TYPE OF ECUIPMENT FEE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR oPlE51 <br />LOT BLOCK_Or�✓fN.'i/R!r <br />AIR COND. UNITS-H.P. EA. <br />S_ I <br />REFRIGERATION UNITS-H.P. EA. <br />BORERS-H.P. EA. <br />I <br />GAS FIRED A.C. UNITS-TORINAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />JOB ADDRESS <br />�,�q <br />F3M <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />%ENTILATION FAN <br />RANGE HOOD <br />1 <br />AIR HANDLING UNIT- C.F.M. <br />N <br />TYPE OF FIXTURE OR ITEM <br />F E <br />INCINERATOR <br />I <br />WATER CLUSET (TOILET) <br />f <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOL"ER <br />KITCHEN SINK fl OISE, <br />SUB TOTAL S <br />1 99 <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />TOTAL FEE $ <br />Iwj <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED HIS AP <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, TI4E GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />X If <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />-1 <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR ETC.) <br />SUBTOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />S y pjj <br />RACTOR OR AUTN.AGENT DATE <br />SIGNATUrIE OF CONT DATE <br />;IDEYARDSETBACK <br />STREETSETBACK <br />REAR YARD SETRACR <br />PLAN CHECK NUMBER <br />W471 <br />PLAN CHECK <br />FEE 3)),W <br />FEE <br />RECLJEI.WQ. <br />USE ZONE <br />LOi AREA <br />VACANT SITE <br />[]YES ONO <br />FEES <br />VALUATION <br />FEE <br />i YPE OF CONST. <br />OCCUPANCY GROUP <br />WO UNI OS DWELLING <br />BUILDING <br />S vw0Yww 7m <br />I/� <br />�(� IrAP <br />.;12E OF BIDO. <br />NO. OF STORI S <br />AX. OCC. LOAD <br />PLUMBING <br />91� <br />I iRKONE <br />AS <br />FIRESPAINKLERS <br />RrOUIREO <br />[DYES ONO <br />MECHANICAL <br />_ <br />OTHER <br />7PIE✓' <br />OFM <br />6PECIAL CONDITIONS <br />I <br />I <br />--_ <br />PENELTY <br />SEC. 303 In) <br />I <br />TOTAL <br />— <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) T HIS IS YOUR PERMIT <br />y / <br />I] <br />II'LIU,1'.ON pCCFYTEORY RLANS CIIFPY AMROVE 6"IRNIf PY <br />I <br />