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"�� ' C'�NSTRUCTION p <br /> ��N� <br /> everett PERMIT PERMITNQ:- 2OJ7T. <br /> 259 -8745 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBtNG ❑ SiGN <br /> ONNER MAIL IIDORESS CITY ZIF PMONE <br /> Roy DeRouir� 2214 Broadwap Everett 98201 252-7112 <br /> �nfMRECT W[EniG1E9 MA:L IIDORE55 CrtY ZIP R10NE <br /> GENEHAL CONTMGTOF M�IL�DDRES$ GTY ZIP RIONE LICENSE• <br /> MECMRNICRL G(MTRAQpR MMl ADDHE55 CITY ZIV PMONE LICENSE� <br /> Oaner <br /> PLVAIBMG COHTRnCiOR MRIL AODRE55 CRv ZIP PNOVE UGENSE� <br /> G1A550!Wq1N <br /> �MEN ❑ AODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ lUILDIN6 IIELOC11T10N <br /> V�W�TION OF WORN <br /> f <br /> DESCRIBE WORK <br /> Inctall gas heater. <br /> HE�TSpURCE <br /> ❑ ElECT111CITY ❑ GI1S O WOODSTOVE ❑ 6TNER <br /> rnovoseo use oF euaoiric <br /> TV Sho I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> P APPLICATION AND KNOW THE SAME 10 BE TRUE AND <br /> LEG�LOESCRiPf10NOiR10PEPTY�SHOWBELOWONFTTRGHfWPGOVlES) CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �or_eia,n _ov GOVERNING THIS TYPE OF WOHK 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 ANV OTHER <br /> I STATE OR LOCAL lAW REGULATING CONSTRUCTION OR <br /> THE PERFORMANCE OF CONSTRUCTION. <br /> JOB�D�uc55 S�GNATURE Of TRRGTOpR AUTIIORIZEO AGENT.OR OVM[R DRTEc��, <br /> 2214 =�l Sroadwa X ,C�c 6 '7 ' �a <br /> /LUMSIN6 MECMANICAL <br /> Np. TYGE OF ill(TURE OR ITEM FEE NO. TYPE OF EOUI�MENT FEE <br /> WATER CLOSET ITOILETI A-C—A/HNDLG UNITS --N P <br /> I BATHTUB REFRIGERATIONUNITS—HP EA _ <br /> LAVATORV(WASH BASIN) CiOILERS—B T U�H P <br /> SMOY�ER GAS FIREO A G UNITS—8 T U <br /> K�r^HEN SiNK 6 DISP 1 FORCED AIR SYSTEMS—B T U M FA S OO <br /> DISHWASHER WALIHEATERS-8TU M <br /> LAUNDFV TRAV UNIT HEAT[RS—B T U. M <br /> CLOTNES WASHER EVAPOPATIVECOOLERS <br /> URINAL CLOTHES ORVEHS <br /> DFINKING FOUMAIN VENTILATION fAN <br /> FLOOR DRAIN qANGE MOOD <br /> BACNFLOW PREVENTERS WAT[R HEATER � <br /> ROOF DRAINS—RAM�EAOERS WOOD STOVE <br /> SINK�SERVICE—BAR.ETC.� METAL FlREPLACE d CHIMNEV <br /> FIREPLACEINSERT <br /> MEATPUMP <br /> 1 fAS PIPING <br /> EXHAUSTFAN <br /> 6U!TO7AL t SUB TOTAL 9 n� <br /> PERMIT t PEPWIT LS �O <br /> TOT11L FEE t TO 0 <br /> FHONt SETB�CN PERR SETBRCv SIOE SETBRCN PLAN CHECN NUMBER FEE RECEI7T NO. <br /> � <br /> USE ZONE lOT RPEA ypGRNT SiTE <br /> ❑res ❑ruo FEES TION FEE <br /> TVPEOFCONST OCCUPANCYGROLIP NOOFDWELUNGUY�TS BUILOING S <br /> PLUMBING <br /> SIZE Oi BLDO NO OF STOPoES MR% OCC IOAO <br /> MECF,ANICAL 24 00 <br /> INVESTIGATION FEE Sec.JO<�e� <br /> FIRE SPpINKLERS f1E0UIRE0 YES NO <br /> STATE BUILDING SURCMARGE <br /> STP.TE EIJERGV SURCHARGE <br /> PPPLILATION/GC�Y f;ANSCNECKEDBY RPPRfORI55U/NCEBY <br /> ORiVEWAY PERMIT <br /> S H TOTAL 24 00 <br /> PERMIT VAUDATON <br /> WMEN PROPERLY VAIIDATED(IN THI$SPACEI THI51S VOUR i'EPMIT <br /> �� <br /> ��� <br /> Q� <br /> � <br /> N <br /> ADDR[SS FILE <br />