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C <br /> die Evergreen r ��ST R�J CT I�N <br /> CITY OF <br /> everett P��nn�T P�R��T No. os752 <br /> CITV HALL 259�8745 <br /> EVERETT.VJA 9ezoi ❑ COMB�NATION ❑ BUILDING ❑ MECHANICAL PLUMBING <br /> O'NNEii IAAIL ADDRE55 <br /> cirr Zia v��oNE <br /> Jack M. Henry 1802 Dull Place <br /> ANCIIREGT OP DESIGNER <br /> MAILADORE55 CIIY ZIP PHONE <br /> GENERAL GONTPACTOR <br /> MAILAODRE55 QTY ZIP PHONE LIGENSEI <br /> 6!EGMANICAL CANTppCTOR MAIL ADDRE55 <br /> GITY ZIP PHONE LICENSE� <br /> PLUA'BING GONTRACiOR <br /> MAILAODPE55 LITY ZIP PHONE IICE'!SE/ <br /> Same � <br /> c�Ass oF woaK <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DENOLITION ❑FENCE ❑SIGN G�RAGE <br /> VAWATIONOF WORK <br /> S <br /> DESCRIBE\YORK <br /> replace water lines <br /> PROPOSED USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMIN[D THI - <br /> �ec�+�oescaianor+oF P�:oreaTv isHow eE�ow oa nrrncH Foua coPies� PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �or e�ceK_oF TYPE OF �'JORK WILL BE COMPLIEC WITH WHETHER SPECIFIED <br /> !'RESUMEOTO GIOVE AU HORITY TO VIOLATE OR CANCEDL�THE P OT <br /> CONOSTRUOCTIOti OR TNE PERFORMANC�E OF ONS RUCT ONrJC <br /> SIGNATURE OF CONiRACTCR OR AUTHORt2ED AGEHT <br /> DATE <br /> �coaooaess X �<y��G 1/9/81 <br /> 1609 Lombard <br /> HANICAL <br /> PLUM3ING —�- FEE <br /> NO. TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EOUIPMENT <br /> AIR COND.UNITS—H.P.EA. <br /> WATER CLOSET�TOILET) qErRIGERATION UNITS—H.B EA <br /> BATHTUB BOILERS—NP.FA. <br /> LAVATORY(WASH BASIN) GAS FIRED A G UNITS—TONNAGE EA. <br /> SHOWER FORCED NIR SYSTEh1S—B T.U. M EA. <br /> KITCHEN SiNK 8 DISP. WALL HEATERS—B.T.U. M <br /> UISITYlASHER IJNIT HEATERS—B�T��� N' <br /> � LAUNDRY TRAY <br /> EVAPORATIVE COOLERS <br /> CLOTHES WASHER CLOTHES DRYERS <br /> � WATER HEAIER VENTILATION FAN � <br /> URINAL ` <br /> � RANGEHOOD � <br /> f1RINKING FOUNTAIN q�q rypNDLING UNIT— C.EM. <br /> FlO0i7 DPAIN S�OVE � <br /> VACUUM BREAKERS MEIAL FlREPLACE 8 CHIPANEY � <br /> ROOF DRAINS—AA�NLEADERS <br /> SINK 1SERVICE—�AR,ETC.) z <br /> a er L.tine <br /> � 2 � SUB TOTAL 5 <br /> SUB TOTAL pERMIT 5 <br /> PERMIT 5 TOTAL FEE S <br /> TOTAL FEE 5 S O p�pN GHECK FEE <br /> SIDE YARD SETBACK STREEi SETBACK REAR YAflD SETBACK PLAN CHECK NUMEER qECEIPT �JO <br /> FEE <br /> � VACANT SITE ' FEE <br /> � USE ZONE LOT AREA FEES VALUATION <br /> GVES ❑NO <br /> TYPE OF CONST. OCCUPANCY GROUP N0.Of DWELLING UNITS <br /> � <br /> BUIIDING S <br /> SIZE OF BLDG. NO.OF STORIES M���'�-��� <br /> PLUMBING 5 00 <br /> FIREZONE BASEMENT FIRESPRINKLEFS MECHANICAL <br /> PEOUIREU <br /> ❑YES ❑NO <br /> APPROVALS <br /> gY DATE OTHER <br /> PENALTY U�C. <br /> 1. ENVIRONMENTAL CHECK LIST SEC.3031a) <br /> 2. BUILDINGPLANS TQ��A� S 00 <br /> 3. FIRE HYDRANT • <br /> PERMIT VALIDATION <br /> � a, FIPE PROTECTION SYSTEM WHEN PFOPERLY VALIDAIED�1N THIS SPACE)THiS IS YOUR FERIdIT <br /> � b13 ;; ,, C' `. QQ —�� <br /> 5 GPADING <br /> G. DRAiNAGE � <br /> Z ENVIRONMENTAL IMPACT Sl'ATPdENT . � . � - . � -•� <br /> . . . .. . � '� iC� <br /> P l� H61LTH DISIRICT . . �� <br /> PLPNS i:H[CKED�� PPPP.FOP ISSUA�?CE f3Y � <br /> rtnp�•,_,,iln.� A(C B� 1 <br /> , f <br /> i i. <br />