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die 6vergreen '^0�S�R��j��O� <br /> CITY OF ��w��� <br /> ever�ett �: FE��n�T �a 09402 <br /> CITVH�LL259�8745 � CQMBI�dATION ❑ BUILDING �7�VIECHANICI�L ❑ PLUMBING <br /> D <br /> EVEAEr.wn �e2o� PHor+e <br /> GITY Z�P <br /> MAIL AUDRE55 <br /> owuen 9 82 O 1 <br /> 2218 Lcmbard Everett PHONE <br /> Pat Wdlkez' ciTr Z1P <br /> MAIL AUDRESS <br /> ARCMRECT OR DESIGNER <br /> Z�p PHONE 'JCENSE 1 <br /> MAIL AODRESS CITY <br /> GENERALCONTRACTOR <br /> MqIL ADORESS <br /> GITY ZIP PHONE LIGENSE s <br /> MecNnruicn�corvrancroa . EveYett 98201 258–z441 _ <br /> Natural Gas Equipmnet 1611 East Grand cTY Z�P PHOYE uc:r+se� <br /> rnna nooaess <br /> PLUMBING COHTRACiOR <br /> CLA55OF WORK <br /> ❑NEW ❑AOOITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN GARAGE <br /> VPLUATION OF WORK <br /> S <br /> DESGRIBE WORK <br /> 7ROPOSEO USE OF BWLOWG I HEREBY ::ERTIFY T4AT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATIO�I AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> �ecnt oesceiarioN oF aaoPenn'�sHow aeiow or+nrrncH Foua coaies� ALL PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> �aT B�°�K—°F HEREIN OR NOT. TIiE GRANTING OF A P[RMI'i DOES NOT <br /> PRESUME TO GIVE AUTIIORITY TO VIOLATE OR CANCEL THE PRO- <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTR�UCTION. <br /> — SIGNAT R[OFCCNTRAGTORORAUT���R�ZEDAGEIJT 6�19/81 <br /> JGd ADDRE55 X ��I� L � '� v <br /> 2218 Lombard <br /> MECHANICAL <br /> PLUMBING TYPE OF EOUIPMENT FEE <br /> TYPE OF FIXTURE OR ITEM FEE Na• <br /> NO. AIR COND.UNITS–N P,EA, <br /> VJATER CLOSE� R'eFR16ERATION UNIiS–H.P.EA <br /> BATHTU� BOILERS–H P.EA. <br /> LAVATORY(WASH E3NSIN) GAS FlRED A.C.UNITS–TONNAGE EA. <br /> SHOWER FORCED AIR SYSTEMS–0 T.U. M EA. <br /> KITCHEN SINK 8 DISP. y�ALL HEATERS–B?.�� M <br /> DISITY✓ASHE��_. UNIT HEATERS–B.T.U. M <br /> Ll�UNOR\ TRAY EVAPORATIVE COOLEFS <br /> CLOTHES'NASHER CLOTHcS ORYERS <br /> WATER HEATER VENTILATION FAN <br /> URINAL RANGE HOOD <br /> DRI.JKING FOI�NTAIN AIR HANOLING UNIT– GF.M. <br /> FLOOR DRFIN STOVE <br /> V�CWId OREAKEFS METAL FIREPLACE 8 GHIMNEY � <br /> ROOF DRAIIJS–RAINLFADERS <br /> SINK(SERVICE–BAR.ETC.) <br /> —�__ S — <br /> SUUTOTAL _ <br /> SUB TOTAL pERM1T E <br /> PERMIT S TCTALFEE S <br /> TOTAL FEE S PLF N CHECK PEE <br /> SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER �EE pECEIPT NO. <br /> LOT AREA VACANT SITE FEES VALUAl'ION FEE <br /> USE ZONE ❑YES ❑NO <br /> TYPE OF CONST. OCCUPANCY GROUP NO.�F DWELLING UNITS � <br /> BUILDING <br /> NO.OF STOFIES MA%.OCC.I.OAD � <br /> SIZE OF BLDG. PLUM�ING <br /> BASEMENT FIRE SPRINKLERS MECHANICAL 7 S O <br /> FIRE 70NE HEOUIRED <br /> IIYES ❑NO <br /> pY OATE OTHER <br /> pPPNOVALS U B.C. <br /> 1. ENVIRONMENTAL CHECK LIST PENNLTV SEC.30?(a) <br /> 2. BUII.DINGPLANS - 7 50 <br /> TOTAL <br /> 3. FIRE HVDRANT PEFlMIT VALIDATION r� <br /> WHEN PROPERLY VALIDATED(IN THIS SPAC�)zH1$IS YOS1F?-?C'JPh�r C� .� -- LF <br /> 4. FIRE PROiEC710N SYS7EM . I � N <br /> 5. GRADING n <br /> G. DRP.INAGE - � <br /> L ENVIRONMENTAL IMPACT STATEMENT � - ' � I� <br /> , i <br /> B. HEALTH DISTRICT � � ' ' <br /> APPLICATION ACC.BY PIANS CHECKED BY APPP.FOR ISSUANCE BY <br /> : '� "..,� � I <br /> 4D'JF'GSS FILE <br />