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�.ai�"�5`'F�'�no� �ONSTIh�UGTiO�`` <br />evere�� PERMIT PERM�T No. 12176 <br />� E��nE�W^4�x°� � �OM6INATION ❑ BUILDIkG ❑ MECHANICAL ❑ �LUMBING <br />OWNER MAILADOAE55 GITV Z'P PMONE <br />CARL NC�_Sn.N. 1232 HOYT E4FeF7T WA 98201 �S$1-?,L9�1�6-C��o�E <br />pRLNITECT OP :n ... �4ER <br />— AUILAODRESS GITY <br />GENERRLCONTdACIOP <br />MAILADOPE55 GITY ZIP PNON' UGENSE� <br />MECMAN�CA�CONTflRGTOfl MAIL POORE55 QTY LIP PMONE .IGENSE Y <br />PLUM9ING CONTRAGTOfl MPIL AOORE55 CITY ZIP PMONE 4GENSE / <br />NEW � ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMu�ITION ❑ FENCE ❑ SIG4 ❑ WOOD STOVFIFIflEPLACE INSERT <br />'105,�100.00 <br />pESCRIBE N ORK <br />r.nnstruct sinale familY residence <br />Residence <br />LEGRL OESCRIPiION OF FflOPENTY ISHOW 6El <br />�or a OLOCK__OF Nassau <br />�oB4007SNassau Street <br />PI.UMBING <br />��0. TYPE OF FIXTURE OF <br />--� WATERCLOSET�TOILE� <br />BATHTUB <br />—J� LAVATORY(WASMBASIN� <br />SHOWER <br />KITCMEN SINK 8 �ISP. <br />DISMWASHER <br />LAU�JDRY TRAY <br />CLOTHES WASHER <br />�RINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />RO�F OFAINS — RAI <br />SINK �SERVICE — BA <br />V-N <br />SIZE OF BLDG. <br />I HEREBY CERTIFY THAT I HAVE FEAD AND :-XAMINED TH�S <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND <br />:ORRECT. ALL PROVISIONS OF LAWS AND ORDIN�NCES <br />'.iOVERNING THIS TYPF OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NGT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONS R�N <br />SIGNATURE CT R OR RU �ORI 0 FGE1 OdTE <br />X �� � /�,�/�— 7/15/83 <br />MECHANIC <br />ITEM FEE NO. TYPE OF EaUlrmtn� <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — M.P. EA. <br />GAS FIRED A.C. UNITS — TONNAG <br />FORCED AIR SYSTEMS — B.T.U. <br />Q WALL HtATERS — 9.T.U. <br />� UNIT HEATERS — B.T.U. <br />EVAPORATIVE C(10LERS <br />CLOTHES DRYERS _ <br />VENTILATION FAN <br />RANGEHOOD __ <br />AIR HANDLING UNIT — <br />STOVE — Y/OOD <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSEBT <br />— HEAT PUMP _ <br />SUB iOTAL <br />PERMIT <br />TOTAL FEE <br />GL�2 <br />1. ENVIRONMENTAL CMECK LIST <br />2.lIUILDINGPLANS � <br />� <br />3.FIREHYDRANT ,p <br />d. FIRE PflOTEG�N SVS7LM <br />S.GRADING! �) <br />.ORAINAUE � � <br />` 7.ENVIR011f.1E�iL4LIMPA6LSTATEM <br />�I.HEALT mSTA T <br />APPLICAiION p(x. BY PLANS <br />� STG Q m� � HWM <br />w <br />f _ <br />S <br />EAF YARD SETBACK PLAN CHECK NUA <br />20 fti 83/72176 <br />'ACANT SITE FEES <br />vYES .'NO <br />LC <br />LOAC <br />BUILOING <br />PLUMBING <br />MECMANICFL <br />OTHER <br />PENALTY <br />SUB TOTAL <br />FEE <br />EA. <br />M <br />M <br />@F.M. <br />FEEZB9.58 <br />�a� <br />FEE <br />S �_ <br />f <br />S <br />CHECK FEE <br />RECEIPT NO. <br />61655 <br />FEE _ <br />0 <br />roTa� 507 0 <br />PERM�T �AIIDATION <br />Wl1EN PROPERLY VALIDATED �III TMIS $P�GE�,THIS I�YiO�P eEf�M�j ( C}1 <br />� y / �� � � 7 �� � <br />� <br />N <br />�;our. RGCEIPTc-+ <br />BY ;;if;NK YOU <br />ADDRESS FILE <br />21���83 <br />V <br />