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fhr !_l�erl'men <br />�,,, ��� <br />everett <br />CITY HALL 259�8745 <br />� CONSTRUCTIO'I <br />PERN�IT <br />PEFiMIT N0. � 4 ' � � <br />[VERETT, WA9B2U7 [] COMBINATIUN � BUILDING ❑ MECHANICAI ❑ PLUMBING <br />OWNER MAIL pDORE55 CITV ZiP PMOHE <br />Brown 8406 8th Place SYOSS S.E. Everett 98204 <br />FRLMITECi OR DESIGNEF MAIL AODRE55 CR1' LP PHONE <br />GENERAL CONTRACTOR MRIL r100RE55 CITY 21P PHONE LICEASE � <br />Fortune Roofina 11216 Hiahw�y 99 Everett 98204 353-3443 <br />MECH4NICRL CONTRAGTJR MA4 ADDRE55 CITY ZIP PMONE IICENSE / <br />i`LUMBING GONTFAGiOR MAi� ADORE55 CIiY ZIP PNONE UCENSE � <br />❑ NEW ❑ ADDITION ❑ ALTERATION Jt,�(REP::9 ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />VALURTION OF WORK <br />s 850.00 <br />reroof Comp <br />PROPOSED USE OF BUILDiNG <br />Single Family REsidence <br />LOT_BLOCN_OF <br />Beverly Lane <br />PLUMBIN6 <br />NOW 9ELOW OR AIIAG' FOUP. COPIES� <br />Pecka 5a� View <br />TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORV�WASHBASIN� <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />DI�MWASHEF <br />LAUNDRY7RAY <br />CLOTHES WASMER <br />WA7ER HEA'ER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF �RAINS — HAINLEADENS <br />SINK (SERVICE — BAR, E1C.) <br />SUBTOTAL <br />PEPMIT <br />TOTAL FEE <br />SIZE OF BLDG. <br />APPflOVALS <br />1. ENVIRON�AENTAL CMECN LI57 <br />2. BUILDING PLANS <br />3. fIRE MYDRANT <br />A. FIRE PROTECTION SYSTEM <br />5. GRADIN(i <br />6.DRAINAGE <br />7.ENVIRONMENTALIMPACTSTAT <br />B.MEALTM DISTRICT <br />APPLICATION ACC. U� PLAP <br />f <br />S <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVIS�ONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OT R STATE OR <br />LOCAL LAW REGULATING CONST ION OR THE <br />PERFORMA�JCE OF CpNST�ON <br />SIGNRTUREO��`ONT9RCT09rZRAUfHORI R T CRTE <br />X f' ^ti //� 5/29/85 <br />N0. � � jMPE OF EOUIPMENT � FEE <br />AIR CJND. UNITS — M.P. EA. <br />REFP'GEflATION UNITS — M.P. FA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UI�ITS — 70NNAGE EA. <br />FORCED AIR SYS7EMS — B.T.U. M EA. <br />WALL HEATERS — P T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTMES �RVERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANOLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIR[PLACE 8 CMIMNEY <br />FIHEPLACEINSERT <br />HE4T PUMP <br />SETBACK IPLAN CMECN NUMBER <br />YES NO <br />NO. OF DWELLING <br />MA%. OCG LOAD <br />PIRE SPRINNLERS <br />REOUIHEO <br />YES NO <br />BT UATE <br />FEES <br />BUILDING <br />PLUMBIIJG <br />IdECMANICAL <br />OTHER <br />PENALTV <br />SUB TOTAL f <br />PEflMIT S <br />TOTAL FEE f <br />PLAN CI <br />FEE <br />VALUATION <br />f 850.OG <br />UBC <br />SEC. ]03 (a) <br />RECEIPT N0. <br />FEE <br />� �� <br />TOTAL I I 16 I 00 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDAif.D piJ THIS SPAGE� THIS IS YPUR PERMIT � <br />� __ O <br />� <br />� <br />i � <br />i�DDRFSS FILF <br />z <br />0 <br />-a <br />� <br />m <br />.., «. <br />�� <br />.. .--� <br />N m <br />C O <br />m � <br />O 3 <br />m <br />J <br />_ � <br />m <br />O 2 <br />C <br />n -� <br />rz <br />.-i .-� <br />--1 � <br />< <br />T <br />O A <br />'T1 Y <br />--i m <br />x <br />m� <br />N <br />O <br />or <br />c� m <br />C N <br />3 tn <br />m <br />zn <br />—� r <br />• m <br />a <br />z <br />� <br />2 <br />D <br />2 <br />1 <br />S <br />N <br />Z <br />O <br />-i <br />n <br />m <br />