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�� <br />cin oF <br />ewerett <br />259-8745 <br />� �'7NSTRUCTION �- <br />PERMIT <br />PERMIT NQ: : I � � � `� <br />� DEMOLITION ❑ COMBINATION ❑ GUILDING ❑ MECHANICAL ❑ PLUMBIMG O SIGN <br />QyypEq MRIlA00RE55 CITY 21P PMONE <br />Angela P. Potts 6703 Beverly Lane Everett, WA 353-1136 <br />MRIL pDORE55 CITV 21P PMONE <br />GENER�L CONTR�GTOR AIAIL ADDRE55 CItY 21P MONE IICFNSE � <br />MECNANIC�LCONTP�CTOR M�ILROOHE55 CITV 21P PMONE UCENSE• <br />Valley Natura7 Gas, Inc. 11323 Highway 99 Everett, WA 355-7730 VALLENG153LI <br />PLUMORIOCONTR�CiOR MRiIADDRESS CITY ZIP PHONE tICENSE� <br />❑ NEW ❑ ADDITION ❑ ALTEHATION ❑ FEPAIR ❑ DEMOLITION ❑ BUILDINC RELOCATION <br />VALUATION OF WORN <br />i i�i95.00 <br />DESLRIBE WORN <br />Install gas gorced air system 100M BUT and 50 gal. AOSmith wacer neater. <br />IEAt50URCE <br />❑ ELECTHICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />Single family residence <br />lOT _ BLOLN � Oi <br />J09�OORE55 <br />6703 Beverly Lane <br />PLUMBING <br />TYPE OF FI7(TURE O <br />WATER CLOSET �TOILET� _ <br />BPTHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 OISP. <br />DISHWASMER <br />LAUNDRY7RAY <br />CLOTHES WASMER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR ORAIN <br />BACNFLOW PREVENTERS <br />HOOF DRAINS — RAINLEADERS <br />SINK �SERVICE —BAR, ETC.) <br />SUB TOTIIL <br />PERMIT <br />TOTALFEE <br />SIZEOFBLDG I NO OF <br />FIRE SPRINKLERS REOUIRED ❑ 1 <br />pVPLICATIONACG�V PUN$ <br />M.M. <br />COP�45� <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION CR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU%EOiCONT TOR AliTll IZEDAGENT.OROWNEN DAT[ <br />X �/i,. // �� �3.�a0.-� 9/8/86 <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />AiC -- A/MNDLG IINITS — H P <br />REFPIGERATION UNITS — H.P. EA. <br />901LERS — B.T.0 /H F. <br />GAS FIREO A C. UNITS — B.T U. <br />FOHCED AIR SYSTEMS — OS.U. M EA. <br />WALL HEATERS — B T.U. M <br />UNIT HEATERS — B T.U. M <br />cVAPORATIVE COOLERS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEfl • <br />WOODSTOVE <br />METAI FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />f SUBTOTAL <br />f PERMIT <br />s TOTAL FEE <br />5mE SEronCK P�pN CHECK NUMBER FEE <br />vncnNr sirE FEES VALU <br />❑YES ❑NO <br />NO Of OWEILING UNITS BUILDING E <br />PLUMBING <br />MA% OCC IOAD <br />MECHANICAL <br />nvan von <br />INVESTIGA710N FEE <br />S7ATE Bl11LDING <br />STATEENERGYSURCHARGE <br />ORIVEWAY PERMI7 <br />: ;7x p�f �i <br />15 <br />15 <br />TOTAL � � 30�50_ <br />PERMIT VALIDATION <br />WMEN PPOPERLV VALIDATED pN THIS SPACE� THIS IS YOUR PERMIT <br />�..�� <br />M <br />� <br />� <br />� <br />l;UI�LG:S f !lE <br />