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O�NContnctw ,_ . NMIb�•2700N <br /> � �:PPLICATIC 1 <br /> "rE� CONSTRUI NALBACH CONSTRUCTION � <br /> everett PERMI <br /> BUILDING DEPARTMENT <br /> 259-87a5 TO BE COMPLETED IN INK ���� <br /> lawrencaH.Nalbac� 21�2HIqh4nAAw. <br /> ❑ DEMOLITION C'fCOMBINATION ❑ BUIIUINO �NIIMC.N�IWC11 EwnIt,WA9E201 N <br /> OWNER M�ILApDRE55 GITV ZiP PHONE - <br /> JOANN p�C-OFictl 191t l�c'w� rr C�rfasrr qY z.� 25z-�S6L <br /> 11FCMITECTORDESiQNER M�IL�pORE55 Citt ZIP PHONE <br /> CKc/� <br /> OENER�L GONTN�LTON M�R ApPRE55 Litt 2iP PHONE LICENSE• <br /> NR�-/��k+r C�NST. Z13L yI(_y���,..o AcC E�Eh6TT �g�� tS�-74S� n+9cry�c..yL;aoy <br /> MEGN�NIL�LCONTR�GTOq M�LL�DDRE55 CITY 2iP PNONE LICENSE• <br /> PLUMSIN6CONTP�GTOR MMIADDpE55 Gltt LIP P��ONE IICENSE• <br /> OA�c OE►r,-,�'; 34 �� kRoHEF E�E�xc�rr 9Yzar 25z- �58o <br /> CL�SS OF WORN <br /> ❑ NEW ❑ ADDITION � ALTERATION � REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIIDING RELOCATION <br /> V�W�TIONOiWOH ICOSTOiMATERI�LSPLUSL�BOR1 <br /> I�c'��Y'�� <br /> OE9GRIBE W RI( <br /> EQU��O ^ uNirS A13o�t cor,HE�4in� 1��ico� <br /> USE OF Bl11LDING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AR <br /> GpHF.. 6�Clnc ��tif'S�oFrT L PLICATIONAPlDKNOWTHESAMETOBETRUEANDCORRECT.ALL � <br /> LE6�lDE5CRIPTIONOFP OVERTVISNOWNBELOWORAiT�GHFOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHENSPECIFIED HERE- <br /> LOT—BIOC�OF IN OR NOT.THE GRANTINO OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL TME PROVISIONS OK <br /> ANY OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION <br /> � OR THE PERFORMANCE OF CONSTRUCTION. <br /> StON�NNE OF CONTR�CTOR OR AUTHORIZED ACENT DATE L^3_g� <br /> X �.�_.� r� �� <br /> PROJEGT�ODRESS APPLIC�NTS CITY BUSINE55 4CENSE NO. <br /> lyty �>Fr-rrr ';�, 33 <br /> RUM�INO MECNANIC�L <br /> NO, TI�E Of RIXTUIIE FEE NO. TYPE OF EOUIPMENT fEE <br /> .. WATERCLOSET TOILE AIRCON� UNITS—H,P.EA. <br /> BATHTUB REFRIGER�TION UNITS—M.P.EA <br /> LAVATORV�WA3M B�91N BOILERS-4.P.EA. <br /> SMOWER QAS FIRED AC.UNITS—TONNAOE EA <br /> KITCMEN SINK 6 D�SP. FORCED AIR SVSTEMS—B.T.U. M EA. <br /> DISMW�SMER W�LL HEATERS—B.T.U. M <br /> LAUNDR�TR�V UNITHEATERS—B.T.U. M <br /> I CLOTMES W�SHER EVAPOR�TIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTIL�TION FAN <br /> DRINKINO FOUNTAIN R�NdE HOOD <br /> � FLOOR DR�IN AIR MANDLING UNIT— C.F.M. <br /> VACUIIM BREAKERS STOVE <br /> ROOF DIUIN9—R�INLEADERS METAL FIREPLACE 8 CMIMNEV <br /> SINNISERVICE—BAR.F';. WOODSTOVE/FIREPLACE INSERT <br /> �U��OTAL BU!TOTAL • <br /> •EIIMIT t PERMIT { <br /> TOUL FEE • TOTAI PEE • <br /> THIS PCIRTION TO 8E COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FqONT SETB�CK AEI1R SETB�CK SIDE SETMCK PL�N CMECK NUM9EH PUN CHECR iEE <br /> �.. �� �• FEE RECEIPT NO. <br /> USEZONE IOT�RE� y��ANTSITE <br /> �'3 �J DYES J�O FEE� V�LU�TION F[f <br /> TYPEO�FC}{OjNST. OCCUP�NLYGROUQP NOAFDWELLINGIINITS � <br /> .1Y.�� R�I � �J �Z � BUILDINO S <br /> SIZEOFBL00 �O.OFSiORIE3 M�%OCC.l0�0 <br /> 4•t�w�t �'t Z / PLUMBING <br /> �+ <br /> MECHANICAL <br /> FIRE SPRINKLERS REDUIRED ❑YES NO <br /> OTHER <br /> PENALTY <br /> APPLiCRTIONSCCBY Pl�NSGMECNEOBY �PPRFORISSpANLEBY i — <br /> TOTAL <br /> /.� L • G, �s.-�a� R�q � �.�►eGs <br /> ���rs ,eea�'.�. <br />