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� APP ICA ON FQR <br /> C�STRUCTIC�N � � <br /> eVerett P�RM IT �'r <br /> DEPT. OF COMMUNITY DEVEIOPMENT SERVICES <br /> ❑TY HALL 259-8745 <br /> EVERETT, lNA9A201 �]��MBINATION ❑ BU!LDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> O\YN[R b1AllADDNE55 CIiY ].IP PIIO.'a[ <br /> i��n.t�A�l�� �d-1�5w1�GJ SSoo GJCJllaizw.l uM1 G��ta� 3S 3-�I`'t v <br /> ARCMITFCTOF.O[SIGNfR M1UilA00N155 CItY ZII' Pf10NE <br /> C[N[RALCONiRACTOR AUILAOOR[SS CIiY 211' PHOYE IICENSFp <br /> htMc� s�l�a �oa.P. �7�9 x..�a� ;a.�,a�r, �_�a-oa�!� �,i-.« �s , <br /> �z�z e� <br /> MKHhuIUL COUTRACIOR MAIL ADONE55 CIIY 11P f'HONC IICENSE p <br /> PWMOINGCONiRAQOR AINLADORE55 CRY ZIP PHONE Uf.ENSfF <br /> CLASS O!N'OXK <br /> ❑NEW ❑ADDITIUN ❑ALTERATION ❑REPAI(i ❑DEMOLITION ❑FENCE IGN ❑GARAGE ❑DUILDING RELOCATION <br /> vnwnno�+or woaK I <br /> S ZSOO� � <br /> DLSCHIIiC\VORK � " � �. <br /> Mou'o GNh�. Po�.0 S�lvrJ or,� pf�P• r.rL-� S(F �L�uw�. StG+�S Q—c2-PCV'a�--� � <br /> rnorusmuseovnuurnne I HEREDY CCRTIFY THAT I HAVE READ AND EXAMINED THIS AP- I <br /> PLICATION AND KNOW THE SAME TO f3[TRU[AND CORRECT ALL <br /> L[GALDES[RIPIIONOfPHOPkRTY�5110\VNpElO\M1ORATiACHfOURCOPIE51 PROVISIONSOf- LAWSnNDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL 6E COMPLIED WITH WHETHER SPECIf-IED HERCIN <br /> ioT oioc�__or OR NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRnVI510N5 OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE P[RFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF C /yY�RACTOR ft AUTHORIZED AGENT DAT <br /> IOIIADDRESS �" I 1 1��� 5 <br /> X � / <br /> PLUMBING MEC ANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOLIET) AIR COND. UNITS—H.R CA <br /> PATHTU� REFRIGCBATION UNI75—H.P.CA <br /> LAVATORY(WASH 17ASIN� 1301LER5—HP. EA <br /> SHON'ER GAS FlRC�A C.U`11T5—TONNAGE [A <br /> KITCHkN SINK& �ISP. fORCC�AIR$YSTEMS-13.T.U. M EA <br /> DISi4A>IIER \Y�LL HfATERS—[�.T.U. M <br /> LAUNDRY TRAY UNIT HEATFRS—f1.T.U. M <br /> CIOTHES lYASHER EVAI'ORATIVE COOL[RS <br /> \VATER HEn'.tN CLOTHES DRYERS <br /> URINAL V[NTILATION FAN <br /> DRINnING POUNTAIN RANGE HOOD <br /> ROOH DRAIN AIR INNULING UNIT— C.FM. <br /> VACUL'M I7R[AKERS ST��'� <br /> ROOF DRAINS—RAIkLEADkRS �V[TAL FlNEPLACE F CHIMNEV <br /> SINK(SERVIf.(—f1AR,ETC) <br /> SUBTOTAL SUBTOTAL 3 <br /> PEFMIT f PERMIT f <br /> TOTAL FfE 5 iOTAI FEE S <br /> SIDE YARD SETBACK AREET SETOACK REAH YARD SCTIIACK PIAN CHECK NUM[fFR PLAN CHECK FEE <br /> fEE NECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> ❑YES ❑NO FEES VALUATION FEE <br /> TYPE Of'CONST. OCCUPANCY GHOUP NO.OF OWELLING UNITS <br /> ❑UIL�!NG SA�� CJ /n �U <br /> SIZE O� IILOG. NO.OF STORIES A1n%.00C LOA� �� ._ �� <br /> PlUM1iINC <br /> FIHFlONE OASEMENT 11fDROOh15 1'IRESPRINKIFNS <br /> NEQUIRED MECHANICAL <br /> ❑YK ❑NO <br /> APPROVALS BY DATE OTHEN <br /> 1. CNVIRONMCNTALCHECKLIST U.13.C. <br /> PENALTY SEC.303(a) <br /> 2. IIUILDING PLANS <br /> J. (IRE HYDHANT TOTAL �z U <br /> S f IRf PROTCCTION SYSTEM PERMIT VAIIDATION /'� <br /> \YII[N PHOPEN�Y VALIDATED(IN THIS 5 F! 15;f$VOON CERMR <br /> i f,li�UWG,I%G1A'AiION ti CLf ARINGIGRU11111NG ' . � ' V ,� <br /> �� ounir+nct �L�.15 �ZEr+r2lG/JL ,)� 7�L�2��1�� <br /> � <br /> 7. [N\'BONh7FNTAL IMPACT STATkM(NT .C/� .( f <br /> / l. i�. <br /> tl HEALTIIDISTHICT /h � L. . �",f <br /> APNUCATION ACC 14Y P 5 QIfCK D 111' API'B. fOR IS1UANCt I{Y SQ � ;� � <br /> � `L(// <br /> �,�>- ^ �i-�S-7� _ �-io /'2o�E�7r�' \ � ' <br /> �r� �z ���5 q �� � �� <br /> <�,-r, <br /> — BEybci� ��ul G�,vE <br />