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r <br />IAR EPPrprnen P''PLICATION FOR Pe <br />CITY w,;ONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />T EVERETT. %VA 9820, ❑COMBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN NSII WUxISS (II, !II' <br />�.9 Qu } ��4 <br />%d l ➢ �/! '%` <br />7 /31 7r,d <br />nAYS [a� 9�17I 42 � - <br />CIN}} ICO IRACIOR / <br />.n <br />r MAB ADDRESS <br />/ CITY <br />ZIP P O L L Cf S[ <br />4- 9d 3�5 =96�7J � rro_9 <br />/ 4 "z, <br />(,,f, , <br />r04p tJ'3 <br />r MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />, IJ, <br />CIP PHONE HCl NSL R <br />Vi <br />NUMBING CONTRACTOR <br />MAIL ADDRESS <br />III, <br />ZIP PHONE LICENSER <br />CLASS OI MONK <br />❑NEW ❑ADDITION <br />ALTERATION ❑REPAIR <br />❑DEMOLITION <br />OUNCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of NORA <br />DESCRIBE MONA <br />P <br />Liq <br />L <br />I HFREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED usI or xmpmlNc <br />/O V <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />T„ J - <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />ucn DIs MPnoy �or Paorl ar aHL�wN MlOsr oa AI1ncH roux coNlsl <br />�-6 R �T - <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />Dl 7y ,Ey /. <br />�lOF <br />OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />.=' <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />_ <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONIRACTOR OR AUIHORIZED AGENT DATE <br />X �� • , <br />JOB ADDRESS <br />d <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />M AIIR CLOSI I HOLIETI <br />AIRCONp UNITS —TIP 1A <br />NI IRICIRATION UNITS—H P IA <br />BV 111UN <br />IQIILRS—H P !A <br />IAV VORY ISAASH BA5IN1 <br />SDON I N <br />GAS F IRI D A C UNITS —TONNAGE EA <br />FORCED AIR SYSTIMS—BTU A1lA <br />KIICIII I: SINK A DISP <br />S\All llln Tl RS—NIL' AI <br />UISSM1ASIII N <br />L'NI11H AlIRS-111U AI <br />LALNDNY TRAY <br />1 \'nf`ORnTIVf COON RS <br />1 1 OTHI S SCASHI R <br />SSAIIR "FAULT <br />CIOT141S DRYIRS <br />VINULATION FAN <br />LX�NAI <br />DRINKING FOUNTAIN <br />RANGE MOOD <br />AIR HANDLING UNIT— C I M <br />MOON DRAIN <br />VACUUM BREAKERS <br />STOAl <br />ROOF DRAINS—XAIHIt ALI ITS <br />5111 AI I IRE PI Al E A C14IMNE Y <br />SINK (SERVICE —BAR. I IC I <br />SUBTOTAL S <br />SUB TOTAL <br />PERMIT IT <br />PERMIT <br />! <br />IOTA( FEE S <br />TOTAL FEE <br />IF <br />SIDE VARIJ St IIIACK <br />SIR[ t L SI TRACK REAR <br />YARD $f 111ACK <br />PLAN CMKK NUMBER <br />PLAN <br />Q I <br />CHECK FEE <br />RICI FETE NO <br />—f <br />111 V l <br />Q 30 <br />USE ZONE <br />lOi AREA <br />VACANT SIZE <br />FEES <br />VALUATION <br />I[[ <br />OYIS ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP NO <br />OE DYVEILING UNITS <br />IFUILDIN(1 <br />yy <br />A��, 141Q <br />SIZE Of BIDG <br />NO OEM <br />MAX OCC LOAD <br />NUMBING <br />FIRE ZONE <br />BASIMENI <br />III ,Ro ()SIS <br />Ilxl SFRINKLLRS <br />REQUIRED <br />A11Cl1ANICAL <br />-- <br />OYES It,N'O <br />APPROVALS <br />RY <br />DATE <br />OICIR <br />1 ENVIRONNILNTALCEIICK LIST <br />PI NAll1 <br />UNC <br />EC 10RA1 <br />2 BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />A FIRE PROUCTIONSYSHM <br />PERMIT VALIDATION <br />W IIIN PROPERLY VAHDAIID (IN THIS SPACD THIS 15 YOUR PERMIT <br />S GRADINGII KCAVATION A CIE ARINGIGNULFRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT[ <br />A hTALT1IDISTRICT <br />APP.ICATION ACC BY <br />PLANSCHICKEU BY <br />APPR FOR ISSUANCE IO <br />9179 <br />i <br />L <br />V <br />