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� . _. -- <br />. ��he £rr.green � : - , � <br />e�erett � �ONSTRUCTIO��� � �- :-� �� <br />PEF�II�IT PERMIT D10. 16174 r' <br />CITV HALI 259�8745 <'�"' <br />o-� ; <br />L suza�rr�i�'s�z�i y[] Cfi1MdINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNE.R MAIL AppRE55 CITY 21P � PMONE <br />Crow-Western <br />�-, <br />ARCHITECT OR DESIGNEH MAIL ADORE55 CITY ZIP PMONE <br />GENEPnL GONTRACTOR MAIL ADDRE55 GTY i1P PNONE LICENSE II <br />same <br />MEGMFNICAL CONTRACTOR MAIL ADDRE55 CITY 21P PNONE LICENSE � <br />PLUMBING CONTPRCTOR MAI� A�ORESS CITV IIP PNONE LICENSE � <br />BXNEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOO� S70VFJFIREPLACE INSERT <br />VALI'ATION OF WORK <br />=356,250.00 <br />UESCRIBE WORK <br />LOT _BLOCN _OF <br />JOB <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />p] <br />BATMTUB <br />LAVATORV�WASM BASIN) <br />SHOWER <br />KITCHEN SINK 8 OISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />C�OTHES WASHER <br />WATER HEATER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKEFS OSB <br />ROOF DRAINS — RAINLEAOERS <br />SINK ISERVICE — BAR, ETG.) <br />PERMIT <br />TOTAL FEE <br />V-#�/�2._. R <br />SIZE OF BLDG. N0. Of <br />1 <br />FIRE ZONE BASEM <br />APPROVALS <br />1. ENVIRONMEN7A� CHECK LIST <br />2. BUILDING PLANS <br />3. fIRE HYDRANT <br />a. FIRE PROTECTfON SYS7 <br />—.5. GRAUING <br />6.ORAINAGE ' <br />: 7. ENVIRONMENTALIMPAi <br />=-B.HEAL7H OISTRICT � <br />t: <br />i � <br />ATfAGH FOUR COPIES� <br />i <br />S <br />5 <br />4CANT SITE <br />YES NO <br />I YES <br />BY PLANS CHECKED BY APPR.FORISSUANCE BY <br />n <br />II J.E.F. I L.C. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND nRDINANCES <br />GOVERNING THIS TYPE OF WORK WILL DF COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THL= GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHURITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFONMANCEOFCONSTRUCTION. <br />SIGNATURE Of�NTgxiOR OH AUTtlORIZ6�/AGENT GATE <br />MECNANICAL <br />TYPE OF EOUIPMENT <br />AIR COND. UNITS - H.P. EA. <br />REFRIGERATION UNITS - H.P. EA. <br />BOILERS - H.P. EA. <br />GAS FIRED A.C. UNI7S - TONNAGE EA. <br />FORCED AIR SVSTEMS - B.T.U. M EA. <br />WALL HEATE(iS - B.T.U. M <br />UNIT HEATERS - B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD VL'17t1e5S <br />AIR HANDLING UNIT - C.F.M. <br />STOVE - WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIPEPLACEINSERT <br />HEAT PUMP <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTV <br />SUB TOTAL 5 <br />PENMIT 5 <br />TOTAL FEE 5 <br />PLAN C <br />FEE <br />VALUATION <br />s356,250.0 <br />�a) <br />FEE <br />RECEIPT NO. <br />FEE <br />1073 65 <br />rora� � � 1527 � 65 <br />PEHMIT VALIDATION <br />WHEN PROPERLY VALIDATED QN THIS$P�C�EATHIS IS YOU(iLI ER�A17 _�� <br />l � C i � � � <br />� <br />((1 <br />.. .. . .' . � �. . <br />ADDR[55 FIIE <br />:. . � <br />