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An <br /> t _1PLICATION FOK <br /> Cl"OF CAFEF OCONSTRUCTION <br /> I <br /> everett PERMIT .�J <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br /> [I DEMOLITION 11 COMBINATION &6 LDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWN R MUl ADDRESS � CITY :IP PHONE <br /> 71c,llt3tl NoYdcrJ 3�9 _,/ FL) <br /> S1_ Filers// 4 ZL3 355-7 52 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY 1u' PHONE <br /> GFjI(RAL ONiq ACTOR MAN ApppES I� CITY 11P PHOHF NICE NSE <br /> (j`LO .--_..__ V <br /> MECHANICAL COIITRACT09 MAIL ADDRESS CITY ZIP PHONE I ICENSE <br /> PLUMBING CONTRACTOR MAIL ADDRESS _ -CITY ZIP PHONE LICENSE <br /> CUSS OF WORK ; <br /> ❑ NEW DDITION ❑ ALTERATION 11 REPAIR ❑ DEMOLITION Cl WOODSTOVE/FR PLANSERT ❑ BUILDING RELOCATION <br /> VALUATION OF WORK ICOST OF MATE MLSPIUS IABORI 1 <br /> SIP <br /> DE CRIBE WORK I _ / <br /> I <br /> �o eL A Y % �-tom P w Irh s�tetrn ANd (�orvL �eef' <br /> USE OF BUILDING pQ I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br /> Ftlm�lLr eoe) rr\ PLICATIONANDKNOWTHESAME TOBETRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OFFROPERTYISHOWN BELOW OR ATTACH FOUR f-OPIESI PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br /> loT_BLOCK—OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> ttt OR THE PERFORMANCE OF CONSTRUCTION. <br /> NAT URE OF CONTRACTOR OR AUDIT RIZED AGENT DATE <br /> X I S Ju 7 <br /> PROJECT ADDRESS APPLILA TSCIII BUSINESS LICENSE RC, <br /> 3244,o'�'Cl, ST <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE !� <br /> WATER CLOSET(TOILET) AIR COND UNITS-HP EA I' <br /> BATHTUB REFRIGERATION UNITS-H P EA. I <br /> LAVATORY(WASH BASIN) BOILERS--H P EA <br /> SHOWER ica GAS FIRED AC UNITS-TONNAGE EA <br /> KITCHEN SINK A DISP. FORCED AIR SYSTEMS-B T . MEA <br /> DISHWASHER WALL HEATERS-13 T.U. M <br /> LAUNDRY TRAY UNIT HEATERS-9 T M _ <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> CLOTHES DRYERS _ _ I. <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE ROOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C F M <br /> VACUUM BREAKERS STOVE `• <br /> ROOF DRAINS-RAINLEADE RS METAL FIREPLACE A CHIMNEY <br /> SINK SERVICE-BAR,ETC) WOODST VE/FI EPLACE INSER' <br /> (K <br /> s <br /> BUB TOTAL _ BUB TOTAL__._ 111- <br /> 1: <br /> PERMIT A PERMIT ___ A I, <br /> TOTAL FEE A _ _._ TOTAL FEE <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL ' <br /> i' <br /> FRONT SETBACK HE AR SE TRACK SIDE SETBACK PIAN CHIC NI1MTER mss/ �(ELLAN CHECK FEE r� � <br /> 20 Z UIS�FEE ._1L RECEIPTNO <br /> uSF.CONT NOT AREA VACANT SITE <br /> R' Z �6 ff.00 DYES O FEES VALUATION FEE <br /> TYPO 01 CIIO//N51 OCCUPANCY GROUP NO OF DWELLING UNITS 5 <br /> AY—` N /?_ / BUILDING <br /> BIZE Or p100/ ^�A NO OF ST/Ns MAX OCC LOAD <br /> IV,-4 . PLUMBING M - <br /> E� IA:L I <br /> MECHANICAL a <br /> FIRE SPRINKLERS REQUIRED D YES NO Jam. <br /> OTHER l <br /> PENALTY <br /> APPLICATION ACC BY PLANS bI[CKfp By APPR FOR ISSUANCE DY WWW«< <br /> TOTAL <br /> �.�. � �. • G, � SSS*-�-!s� �cc� l�Ec.P <br />