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�hi'Ll�erereert ;O N ST R U CT I 0 R' <br /> �:�.,�� r.� i. <br /> �V����� PERMIT PERM!T NO. l�� •� � <br /> CITV HALL 259�6745 <br /> �veHerr,wa 9ezoi �] COMBINATION ❑ BUILDING �+ MECHANICAL ❑ PLUMBING <br /> G':R+eR �AAILFDDRE55 CITY ZIP PHONE <br /> THOMAS MOFFETT 1502 IAMBARD EVERSTT 252-771� <br /> FFCHITEGT OR�ESIGNER IAAIL AODRE55 GTY 21P PHONE <br /> GENEPhLCONTRAGTOR MAILADDRESS GIiY ZIP FHONE LiCENSe� <br /> MEGMhNIGAL CONTRPGTOR MAIL ADOFESS CITY ZIP PHONE LICEhS[a <br /> VALLEY NATURAL G11S 519 S. E. EVERETT MALS, WAY 353-3535 <br /> PLUMOIfJG CONTRACTOR IdAIL ADDPE55 GITY ZIP PHONE LILENSE x <br /> GLPSS OF WORK <br /> ❑ NEW ❑ AODITION � ALTERATION ❑ REPAIF ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ VJOOD STOVEIFIREPLACE INSEFT <br /> VALUATION OF WORK <br /> S <br /> DESCRIOE WORK <br /> REPLACE HOT 47ATER HEATER <br /> PROPOSEC USE OF PUILOIVG <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> �ecnioescnivnovoFVRoaearv�sHowee�owoanrrncHFouacovies� CORRECT. NLL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVEflNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> �oT_e�ocn_oF WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OF <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMP. E OF CONSTRUCTIONr <br /> J0�ADDitE55 SIGNATUFE O ONTR OR OR PUT IORIZ � -'DATE <br /> ��'����'���i' 8/23/84 <br /> 1502 LOMlHARD X ; i !' //� /.i' � <br /> MEC IC � <br /> PLUMBING '��/� <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E PMENT FEE <br /> WATERCLOSET�TOILET) AIR COND. UNIj�-' .P. EA. <br /> BATMTUB flEFRIGERATfYjN UNITS — H.P.EA. <br /> LAVA70RY(bVASH BASIN) 801LERS— H.P. EA. <br /> SHCWEFi GAS FIRED A.C. UNITS—TONNAGE EA. <br /> KITCHEN SINK&DISP. FORCED AIR SYSTEMS— B.T.II. M EA. <br /> DISHWASHER WALL HEATF.RS— B.T.U. M <br /> LAUNDRY TRAY UNIT HEATERS — B.T.U. M <br /> CLOTHES WASH[R EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DPYERS <br /> URINAL VENTII.ATION FAN � <br /> URINKING FOUNTAIN PANGE HOOD _ �. <br /> FLOOR DRAIN AIR HANDLING UNIT — GF.M. �. <br /> C: <br /> VACUUM BREAKERS STOVE — W�OD ' <br /> ROOF DRAINS— RAINLEADEFS METNLrIFEPLACE&CHIMNEY <br /> SINK�SERVICE — BAR, ETC.) FIREPLACEINSERT <br /> HEAT PUMP <br /> H � <br /> H �- <br /> � � <br /> t <br /> SUB TOTAL E _ SUB TOTAL S e_ � � <br /> PERMIT S PERMIT 5 10 0 C% � <br /> TOTAL FEE S TOTAL FEE E ],tj Q "�J �. <br /> SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CMECK FEE <br /> FEE RECEIPT NO. <br /> � ; <br /> C'7 <br /> USE ZONE LOT AREA VACANT SITE ' <br /> . .YES NO FEES VALUATION FEE � : <br /> TYPE OF GONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> t" : <br /> F+ <br /> BUILDING $ a r <br /> SIZE OF BLDG. NO.OF STORIES Mf+X.OCQ LOAD <br /> PWMBING - <br /> FIRE ZONE BASEMENT FIRESPRINKLERS MECHANICAL <br /> PEOUIRED , <br /> VES NO <br /> APPROVALS BY DATE �THEF � � <br /> L ENVIRONMENTAL CHECK LIST PENALTY U.B.G C <br /> SEC.303(n) <br /> 2.�UI�DING PLANS F' <br /> TOTAL <br /> 3.FIFE HYDRANT <br /> 4.FIRE PROTECTION SYSTEM PERMIT VALIDATION � <br /> 5.G9ADING WHEN PROPERLY VALIDATED pN THIS SBACE)THISlS Y j UA P,ERMIT �] <br /> 5 <br /> P'1 <br /> 6.DRNINAGE � <br /> 7.F:NVIRONMENTALIMPACTSTATEMENT ('�� <br /> 8.rIEALTH GISTRICT �� � � � ' •—• <br /> I; : <br /> APPLICdTION ACG BV PLANS CHECKED BY APPR. FOR ISSUANCE BY <br /> 1C lC <br /> !,Cn2[�� fIIJ=. <br />