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u,e ��.�,� <br />CITY OF <br />�verett <br />259-8745 <br />"` C''`�NSTRUCTIO(V -- r <br />PERMiT <br />PERN,AIT NCd. �� 7 � 2 <br />❑ DEf�IOLITION OiCOMBINATION ❑ BUILDING ❑ MECIIANICAL ❑ PLUMBING �) SIGN <br />OWN[R MAILADDRESS CiiY LIP `HONE <br />R. R. Pierre 8016 Beverly Blvd Everett WA 98203 353-2980 <br />pRCHREGTOR0E5iONEB M/.IlAD�1VE55 CITY 21P PHONE <br />GENER��LdITP�CIOP MRILAOORE55 GITY 21a PMON° LICENSEr <br />Same <br />MEGN�NICALCON1PRCtUfl MRILADCRE55 CITY ZIP VMONF, UCENSE� <br />PLUMBING CONTR�CTOR MAR �DDf1E55 CITY ZIP PMONE UfENSE � <br />GlA55OF WONIt <br />� NEW ❑ ADDITION C] ALTERATION ❑ REPAIR ❑ UEMOLITION ❑ BUILOING RELUCATION <br />s 46,000 <br />OESCRIBE WONN <br />Install modular home on foundation <br />HE�TSOURCE <br />❑ ELECTHICITY ❑ GAS ❑ WOODSTOVE <br />Single family r�sidence <br />LOT � .V_. BIOLK � <br />�8t� 8everl y Bl vd <br />pLUMBING <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY�WASH BAE <br />SHOVJER <br />KITCMEN SINK 8 DISP. <br />DISHWASMER <br />LAUNDF�TPAV <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />RUOF DPAINS- RAINLEADERS <br />SINK ISERVICE - BAH, ETC 1 <br />SUBTOTAL f <br />PERMIT S <br />TOTALFEE S � <br />�R SEl �FCN SI�E SETBACK <br />20' 6' <br />' AREA yqCANi SITE <br />�ne _n CiMES ❑NO <br />TYPE OV CONST. <br />v-n <br />S12E OL OLOG NO Of <br />� <br />PCC BY � 1'LANSCHECNEO�Y <br />JEF <br />[�� <br />❑ OTHEH <br />I HE9EBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SA;,AE TO BE TRUE AND <br />CORREI:T. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTINCa OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL TH[ PHOVISIONS OF ANY OTHER <br />STATE OR LOCAL lAW fiEGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTFUCTION. <br />SIGNATURE OF C�O,N�T TO AUTM qiZEA r1GENT, OR OVMER �4TE <br />x ,-�/�,�(� � _...�,.-� �1.. /� lf'E <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT <br />� O OO A/C - A/HNDLG UYITS - HP. <br />FEFRIGERATION UNITS - NP. EA. <br />� BOILERS -- i1.T U./H P. <br />GAS FIRED A�C. UNiTS �- B.TL. <br />5 FORCED AIR SVSTEMS - B.T.U. M EA. <br />5 OO WALLHEATERS-B.T.L' M <br />UNIT HEATEFS - B.TL. M <br />5 OO EVAPORA7IVE COOLERS <br />CLOTHES�RVERS <br />VENTILATION FAN <br />RANGEHOOD <br />� WATER HEATER <br />WOODS70VE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPINC <br />EXHAUSTFAN <br />RP�'R FOR ISSUANLE OY <br />LC <br />PLANCHECKNUMBER <br />86/16712 <br />FEES <br />BUILDING <br />PLUM�iNG `+ <br />MECHANICAL <br />INVES7IGATION FEE <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />FEE RECEIPDf <br />iY�i3� 80495 <br />STATE BUILDING SURCHARGE <br />STATFENERGVSURCHARGE <br />DRIVEWAV PERMIT <br />TOTAL <br />PERMIT VAIIDATION <br />WMEN PFOPERLY VALIDnTE� �I1J <br />. <br />'�U!',.. i�� <br />Y�7��1 <br />��1 <br />HATEfi 5400.00 <br />1 50 <br />15 00 <br />2� �0 <br />FERMIT <br />�� <br />t� <br />l�- <br />SCUIT�Ei <br />•-- <br />