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EDeweert <br />clTv of r <br />C( NSTRUCTION <br />everett <br />�( C q <br />PERMIT PERMIT NQ: I �U2 t <br />259-8745 <br />M DEMOLITION ❑ COMBINATION ® BUILDING ❑ MECHANICAL '❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP PHONE <br />Nutri-System, Inc. 3901 <br />Commerce Ave Willow Grove, PA 19090 (215) 784-5600 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP PHONE <br />T/A Const. Co. 15249 NE <br />90th St Redmond, WA 98052 882-3519 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSER <br />T/A Ccnst. Co. <br />TACON1410K <br />MECHANICAL CONTRACTOR <br />_ _ <br />MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />EkALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />$ 7,500.00 <br />OGSCRIBE WORK <br />Tenant improvement <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS <br />❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />retail weight loss clinic <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />lOT —BLOCK _ OF <br />WHETHER SPECIFIED HEREIN OR NOT. THE ;RANTING OF A <br />PERMIT DCES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR. A RIZE OWNER DATE <br />.JOB ADDRESS <br />1203 3E Sl,�e ,tt Mall Way <br />3 8�� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS — B.T.0 /H. P. <br />SHOWER <br />GAS FIRED ABC. UM FS — B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />(SERVICE — BAR. ETC.) <br />METAL FIREPLACE & CHIMNEY <br />-}—SINK <br />I <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />$ <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT <br />TOTALFEE <br />$ <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />- <br />-- <br />-- <br />88/19621 <br />2 64.35 <br />95349 <br />USEZONE <br />C-1 <br />FEE <br />—T <br />LOT AREA <br />-- <br />VACANT SITE <br />OYES (-]NO <br />FEESVALUATION <br />BUILDING <br />$ 7,500, <br />TYPE OF CONST. <br />99 00 <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />V—N <br />B-2 <br />0 <br />PLUMBING <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />IZE OF BLDG. <br />MECHANICAL <br />1911 Sf <br />1 <br />19 <br />INVESTIGATION FEE Sec. 304(c) <br />PRE SPRINKLERS REQUIRED ❑ YES ENO <br />STATE BUILDING SURCHARGE 3 50 <br />_ <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />SH Be <br />Be TOTAL 102 50 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />r— <br />C\3 <br />C.0 <br />M <br />\ <br />ADDRESS FILE <br />