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rhe L'n'rcn�rn <br />everett � �ONSTRUCTI01� � <br />PERMIT PERMIT N0. 15165 <br />GITY HALL 259�87<5 <br />eveaerr. �vn sezo� � COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNCR MAIL AO�RE55 GtV ZIP PMONE <br />ROY 11'ICKLUI'�D PO BOX 532 LAICE STE��NS lVA 98258 355-2207 <br />qqLN'TELi OR DESiGNER MA4 ADORE55 QTv 2iP PNONE <br />GENERFLCONTFPGiOR MAILAD�RESS CIiY Z�P PMONE UCENSE• <br />RIVERSIDE ROOP C0. 2916 STA1'E ST. f'VTRF.TT IVA 98201 258-4646 RIVERR302TD <br />MELHAN�CAL LONTRAGTOF MR�� Ap�PE55 CIiY 21P PMONE IICENSE • <br />PLUMBiNG CONTPAGLOR MAIL AOGRESS CitY ZIP PNONE LILENSE � <br />❑ NEW ❑ AODITION ❑ ALTERATION C� REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WO00 STOVEIFIREPLACE INSERT <br />LATIOpN OF WORK <br />S 20��.�0 — <br />Reroof existing Uuilding <br />aoaoseo use or oui�oiNc <br />WAL DESCRiPT10N OF PROPENtY �SMOW BELOW OR ATTACH FOUR LOPIES� <br />LOT BIOCK_OF <br />i0B ADORES <br />�Q'i7 lh'E'IT10RE <br />PLUMBING <br />N0. TYPE OF FI%TURE OR ITEM F <br />WATERCLOSET�TOILEn <br />9ATHTUB <br />LAVATORV p"JASM BASIN� <br />SHOWER <br />DISHWASHER <br />LAU�'DRVTRAY <br />CLOTHES WASHER <br />WATER NEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINK (SERVICE - BAF, ETQ� <br />TOTAL FEE <br />SIZE OF BLDG. NO. OF STOH <br />FIRE ZONE �ASEMENT <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HVDPANT <br />4 FIRE PROTEC?ION SYSTEM <br />5. GRADiNG <br />6. DFAINAGE <br />7.ENVIRONMENTALIMPACTSTA7EMEN1 <br />B.HEALTH OISTflICT <br />APPUCATION ACC. BY PLANS CHF <br />� <br />S <br />5 <br />EAfl VARD SETE <br />ACANT SITE <br />VES NO <br />O. OF OWELLIN <br />IAX. OCC. LOAD <br />IRE SPFINKLER: <br />EOUIRE� <br />YES NO <br />BY DA1 <br />BY IAPPR.FOR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHFR SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TG ��VE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNAil1RE OrF Ni ACiO/q/��� F A THOR12E0 AGENT p04TE <br />X \�JC� � � //� �/LO/�S <br />MECHANICAL <br />I�O. TYPE OF EOUIPMENT FEE <br />AIR COND. UNITS — H.P. EA. <br />REFRIGEFATION Ut11T5 — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED AA. UNITS — iONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVF COOL'cF5 <br />CL�THES DRYERS <br />VENTILATION FAN <br />RANGENOOD <br />Alfl HANDLING UNIT — C.F.M. <br />S10VE — WOOD <br />METAL FIREPLACE 8 CNIMNEY <br />FIREPLACEINSERT <br />HEAT CUMP <br />BUILDING <br />PLUId81NG <br />MECHAMCAL <br />OTHEH <br />PENALTY <br />SUB TOTAL f <br />PEHMIT S <br />TOTAL FEE f <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />VALUqTION FEE <br />528��.Q� � 38 �5� <br />303 <br />TOTAL I I sR I so <br />PEPMIT VALIDATION <br />WMEN PROPERLY VALIDATED pN THIS SPACE) THIS IS VOUR PERMIT �('j� <br />_' _� <br />'"'{ <br />� <br />�"� <br />ADDR[SS i�IIG <br />