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u,�E„�„�„ <br />CITY OF �� <br />ev�.�rett <br />#sy►'� ��-�a�o <br />(`�NSTRUCTIf�N �� <br />PEFtMIT <br />aER�,T NQ: =19019 <br />❑ DEMOLITION ❑ COMBINATIOW ❑ BUILDING � 1AECHANICAL ❑ Pl.UMBING Q SIGN <br />OWNEP MAIL�OORE55 CI�V ZIP PHCNE <br />Jeanne ➢iifi�KiSlfgB]!�S Weckstrom 804 Madison St. 9810's 353-2218 <br />ARCHITECT OR CESIGNEfl MAIL nD�RE55 QTV 21P PHONE <br />GENENRICONTRACTGR MAILADDNESS CIiY ZIP p�fONE LILENSEt <br />MECHANICNLCOYTRACTON MAILADDRE55 CITV ZIP PMOYE LlCLNSE• <br />Cozy Heating/Gas Div. 20221 67th Ave. NE Arlington, 47A 58223 935-4904 <br />?LUMBINGCONTRRCTOH MAILAOORE55 Cliy ZIP PHONE LICENSEM <br />COZYA:3*7.37NC <br />CLASS OF WOHN <br />� NEW ❑ A�OITION ❑ ALTEHATION <br />VALUATION Of WCRN <br />a 400.00 <br />OESCFIBE WORK <br />Converting furnace to gas <br />HEATSOURCE <br />❑ ELEI:TRICITY ❑ GAS ❑ WOODSTOVE <br />Single family residence <br />. �ESCRIPTION OF PROPEfiTY ISHOW PEI Ow ne niie� <br />LOT _ BLOCK _ <br />804 Madison <br />PLUMBING <br />TYPE OF FI7(TURE C <br />WATER CLOSET (TOILET� <br />BATHTUB <br />LAVATORV�WAGHBASIN) <br />$NOWER <br />KITCHEN SINK 8 �ISP. <br />DISHWASHEF <br />LAUN�RVTRAY <br />CLOTHES WASHEH <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR OFAIN <br />BACNFLOW PREb'cNTERS <br />RO(7F DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR. ETC.� <br />SUBTOTAL <br />PEflM1T <br />TOTAL FEE <br />OF CONST. OCCUI <br />)F BLDG. NO OF <br />SPRINKLERS REOUIflED ❑ 1 <br />CATIONACC.OY PLqNII <br />S.Ii. <br />COP�ES) <br />VAC/ NT SITE <br />❑YES ❑NO <br />❑ �9EPAIR 1] DEMpUTION <br />❑ 6THER <br />❑ BUILDING HEI.00ATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TFIIS <br />APPLICATION AND KNOW 7HE SAME TO BE TRU[ AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK VJILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR �JOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUML TO GIVE AUTFIORITY TO <br />VIOLATE OR CANCEL TliE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGU! ATING CONSTRUCTION OR <br />THE FERFORMANCE OF CONSTFUCTION. <br />SiG4 TU OF CJNTRACTOR. qU �HO i2�ED� /AJGENT, OR OWhER �y � /O�ATE/��j <br />X M �%6 A`�v-"'�/ �V �'(JyJ(' Cl / <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPME <br />A/C — A/HNDLG UNITS — H.P. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — B.T.0 MP. <br />GAS FIR[D A�C. UNITS — B.T.U. <br />FORCSD AIR SVSTEMS — B.T.U. <br />WALL HEATERS — B.T.U. <br />UNIT HEATEPS — B.T.U. <br />EVAPORATIVE CC�JLERS <br />CLOTHESDRVEqS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER • <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACE INSEFT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />PLAN <br />NO.OFDWELLINGUNITS BUILDING <br />OCG LOAD <br />L FOR ISSU/ NCE BY <br />M EA. <br />M <br />M <br />SUB T0T�1L r;'; <br />PEPMIT <br />TOTAC fEE'�. �. i : I �.� <br />CNU.U.6ER FF�E.�. " RECI <br />FEES VALUATION <br />S <br />PI.UMBING <br />MECHANICAL <br />INVESTIGA710N FEE Sec.304(e) <br />STATE BUILDiNG SURCHAHGE <br />STA?EENERGYSURCHARGE <br />DRIVEWAV ?ERMIT <br />FEE <br />TOTAL I I 24I 00 <br />PERMIT VALIDATIDN � <br />WHEh PqppERLV VAUDATED (IN THIS SPACE) THIS IS VOUR PcRM1T <br />Q� <br />r� <br />� <br />�� <br />�� <br />AODRESS FILE <br />