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,,����,��,"��,� :� �ON�TRUCTIO{'� � <br />everett p E R M IT PERMIT NO. � <br />CITY N:.LL 253�c7c5 <br />EveaErT.;u.ya2oi V COMBINATION %X BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OW'+ER �dR:LADOPE55 CITY ZiP PHO4E <br />NELSON VISIOV GLINIC 3203 Hovt FvPratt A'A qR9f17 �52 �m0 <br />RRGHrtELT OF UESiG�:ER MRIL Ap� E5�— GiTY Zio FMONE <br />GENEFnL GONTRAGTOR MRiI AD�RE55 CITY ZIP PHONE LiCENSE � <br />Same <br />MECHArvICAL CONTRAGiOR MFIL AODRE55 GITV ZiP PMONE L�CENSE • <br />PWMBING CONTRPGiOR MAiL ADORESS GTY ZiP PnONE L�CENSE � <br />yM��V y O NEW .� ADDITION ❑ ALTERATION ❑ REPhIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVFJFIREPLACE INSERT <br />VRWRT�ON OF WORK <br />j 45��.�0 <br />x 12 ' winduwed addn and new mansard roof <br />LOT _.,ty_,uYLGK JSLZOF <br />PI.UMBING <br />TYPE OF FIXTURE OR ITEM <br />VJA7ER CLOSET ITDILET) <br />�ATHTI'B <br />LAVATORY �JJASH BASIN) <br />SHOWEF <br />YITCHEI: SINIf 8 DISP. <br />DISHWA(iHER <br />LAl1tIDRt TRAY <br />CLOTF.E:i WASHER <br />WATEH IIEATER <br />URINA: <br />DRINKING FOUNTAIN <br />FLOOR LRAIN <br />VACUUN BREAKERS <br />ROJF DF�AINS — RAINLEADERS <br />SINK (SE4VICE — BAR, ETC.) <br />SUB <br />TO7AL FEE <br />R-5 <br />nnFCM <br />S <br />S <br />S <br />FEE <br />YAR� 5 <br />YES X NO <br />V-N Addn B-2 na <br />SIZE OF BLDG. NO. OF STORIES Mq%. C <br />Addn 72 sf 1 na <br />FlRE ZONE BASEMENT FIRE S <br />AP7ROVALS <br />L ENVIRONPAENiAL CHECK LIST <br />2. BUILDWG PLANS <br />3. FIRE HVDRANT <br />C. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONM�NTALIMPACTSTAI <br />O.HEALTM DISIHIC� <br />PLANS CHECKED BV <br />Stg I �11v711 <br />YES . NO <br />�---- <br />3Y I DATE <br />�C <br />ISSUANCE BV <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAA1E TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OH NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR ANCE OF NSTR�TIO . <br />so•!/+� F CONTFAGTO AUiMOF' D AGE T �ATE <br />X )l�( 2Ltn/Rc <br />NO. TYPE OF EDUIPMENT <br />AIR COND. UNITS — M.P. EA. <br />9EFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />VJALL MEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPOFATNE GOOLERS <br />CLOTHES DflVERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOO� <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLAGEINSERT <br />HEAT PUMP <br />SUB TOTAL <br />PERMIT <br />TCTAL FEE <br />FEE <br />5 32.83 _ <br />FEES VALUATION <br />Ftt <br />� <br />f <br />S <br />�MECN FEE <br />RECEIPT NO. <br />%�___—_ <br />FEE <br />euaoiNc 5 4500.00 50 50 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY U.�C. <br />SEC. 30] (a) <br />TOTAL SO SO <br />PEPMIT VALIDATION � � <br />NJHEN PPOPERLY VALIDATED pN THIS SPACE� TMIS IS YOUR PERMIT � <br />i.c1 <br />� <br />� <br />i� <br />i;CDP.cSii ;-1LE <br />