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lim Everfffern <br />everett <br />1111 NAZI 1$4 EIIE, <br />I"TIFF W11K1M111A11 <br />91"1 <br />011T 011.ommA TV HUM, <br />01VE10 1 <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />IF <br />evclrcltI <br />PLUMBING .e <br />OWNER MAIL AOUM SS !Ir PHONE <br />�. criol. mum We 9�a <br />u,r�,-7tI <br />ARCHITECT OR O SIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />0: <br />PLUMBING CONTRACTOR <br />�11{LMAIL ADDRESS PHONE LICENSE NO, <br />W <br />PERMIT <br />❑ BUILDING N PLUMBING []MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION REPAIR <br />Z <br />~ <br />VALUATION OF WORK <br />f <br />[I DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />W <br />d <br />DESCRIBE WORK <br />1 411 <br />J• i <br />PROPOSED USE <br />MECHANICAL <br />Ty E <br />OF TUEL�OII HAT. ❑LPG. ELEC. <br />GAS <br />I. EGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />FOUR COPIES( <br />IOT BLOCK —OF --. <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />REFRIGERATION UNITS-H.P. EA. <br />BOILEFIS -H.P. EA <br />lU8 ADDRESS Fy�L�� <br />GQ840 <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />—'T-- <br />WAIL HEATERS B.7. U. M <br />UNIT HEATERS-B.T.U. <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />_ <br />RANGEHOOD <br />I <br />AIR HANDLING UNIT- C.F.M. <br />N <br />TYPE OF FIXTUIIIE OR ITEM <br />FEE <br />INCINERATOR <br />I <br />WATER CLOSET (TOILET) _ <br />f T <br />BATHTUB--- <br />__-- <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />SHOWER <br />KITCHEN SINK & DISP. <br />—_ <br />SUBTOTAL III <br />— <br />_ <br />DISHWASHER <br />— PERMIT f <br />TOTAL FEE f <br />_ <br />LAUNDRYTRAY <br />I <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 JAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PRIVATION AND KNOW THE SAME TORE TRUE AND CORRECT. ALL <br />PROVISO NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL RE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE 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 <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />FLOOR -SINK OR DRAIN <br />_ <br />U VACUM BREAKERS <br />ROOF DRAINS-RAINLEADE RS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />S <br />PERMIT <br />TOTALFEE <br />_ <br />SIGNATUREOFCONTRACTORORAUTH AGENT DATE <br />SIDE YARD SETBACK <br />STREETSI_TSACK <br />REARYARDSETRAC <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE (RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />[]YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />T FPE OF CONST. <br />OCCUPANCY GROVP <br />UNiTTS DWELLING <br />BUILDING <br />1 <br />SIZE OF dLDO. <br />NO. Uf STORIES <br />MA%, OCC. LOAC <br />PLUMBING <br />����IIII <br />ii <br />—11= <br />_l <br />I <br />'—T <br />FI O <br />BASE T <br />REGVIRED KL S <br />❑YES ONO <br />MECHANICAL <br />OTHER <br />SPECIAL CONDO IONS <br />_ <br />- <br />nvplp p:n n.n ii.1(np��e•. ��.-I lv �� �rnn_Iblon e.unylT nv <br />PENELTY <br />SEC. 303 Is) <br />I <br />TOTAL <br />SY1 <br />PERMIT VALIDATION <br />WHEN PROPERLY VAI. IDAT ED IIN THIS SPACE) THIS IS YOUR PL Hh'^' <br />