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d�eErerFree�� `�� 1NSTRUCTIOf�i - � <br />CITY OF <br />everett PEF�MIT PERMIT NO.O916Z <br />GTV HALI 259�8745 <br />eveaert. wn sazoi Cy� COMBINATION C� BUILDING ❑ MECHANICAL ❑ PLUMBING <br />01'MEri MNL AU�RE55 CIiY ZII' PNONE <br />Peter ta. Borklund 5114 South 3rd Avenue 258-1665 <br />nRC��rtECi OR D[SiGNER MAIL ADDRE55 QiY ZIP PNONE <br />GENCRALCON1RACi0P AIAiLADDRE55 CILY 21P PNONE UCENSG� <br />Same <br />MECMANICAI CONiRACTOR MNiL FDOR[55 CITY ZIP PNONE LICENS[ � <br />�LUM9INGCANTRACTOR IARILADDRE55 CI1Y ZIP PHONE LICENSf� <br />❑NEW ❑ADDITION ❑ALTERATIOK ❑REPAIR ',}�QEMOLITION ❑FENCE ❑SIGN C3ARAGE <br />5 <br />uescame woarc <br />Demolish single family s� <br />i�r 4 Biar 16 aF TOWn of LoWEl <br />JOB A�ORE55 <br />5119 South %!tK AVenue <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />WATEF CLOS[T ITOILETI <br />KITCHEN SINK 8 [ <br />OISH\YASHER <br />IAUN[�RY 7'RAY <br />CLOTHES IYASHEI <br />WAiER HEATER <br />URINAL <br />DRINKING FOUNT <br />FLOOR DRAIN <br />VACUUM OREAKE <br />HOOP DRAINS — <br />SINK ISERVICE — <br />SIDE YAflD SETBACK <br />TYPE OF CONST. <br />;IZE OF BLDG. <br />PERMIT <br />TOTAL FEE <br />STRE[T SGiUfCK <br />^C:.UPnNCY GROUP <br />1. ENVI90NMENTALCHECKLIST <br />2. BUILDIN� PIANS <br />3. FIRE HVDFANT <br />d FIR'c PROIE:TION SYSTEM <br />5. GRADING <br />6. DRnINAGE <br />7 ENVIRONM[NTAI. V,IPNCTSIDT�1!FNT <br />FEE <br />Garage <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIiIS AP� <br />PLICATION AND KMOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PFOVISIONS UF LAWS AND ORDINANCES GOVERNING TFIIS <br />TYP[ OF WORK WILL BE COMPLIED WITH WHETHER Sf ECIFIED <br />HEREIIJ OR NOT. THE GRANTING Of A PERMIT DOES h0T <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO� <br />VISIONS OF ANY OTHER STAT OR LOCAL LAW REGULATING <br />CONSTR ��/10� R THE P f� RMAN CONSTRUCTION. <br />SiG'vnjG� O! COW OR 0(i �� �ZLD AGENi DAik <br />X ��` r� �� y� 4/22/81 <br />�ORERS — HIP. EP."J <br />GASFIREDAC UNITS—TOI <br />FORCED AIR SYSTEMS — B.T <br />1'�NLL I�LNIt11J - U.I V. <br />U WT HEATERS — B.T.U. <br />EVAPORATIVE COOLEHS <br />CLOTH[5 DRYERS <br />VFNTILATION FAN <br />AIR <br />8 <br />REARVARD SF.TBACK IPLAN CHECK NUMBER <br />L]YES ��NO FEES <br />NO. OF DWELIING UNITS <br />BUILDING <br />MA%.00C.LOAD <br />PLUMBING <br />FIRE SPRINKLERS <br />REQUIREG MECNANICAL <br />' lYES CNO <br />BY UATE OTHER <br />PENALTV <br />TOTAL <br />SUBTOTAL <br />FEE <br />A <br />M <br />M <br />U.B.C. <br />SEC, 303 (o) <br />FEE <br />RECEIPT N0. <br />FEE <br />VMEN PROPERLY VALIDATED QN THIS SPACE) THIS IS YOUR PERMIT <br />, 7 ' �� Q. '�, � -- � <br />c� <br />a--i <br />