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1 <br /> � <br /> thr L'rer�mcn <br /> °��� °� � CONSTRUCTIO' ' <br /> everett PERMIT PERMIT N0. 13OSH <br /> CITY MALL 259�87a5 � <br /> EVEFETT,WA 9820t ❑ COMBINATION ❑ BUILOING � MECHANICAL ❑ PLUMBING <br /> OWNER MAIL AppRE55 CITY ZIP PMONE <br /> . LODY PALICTE 4625 Colbv Av n � v r t+ We 9A9Q] 758_31oa <br /> hqCHITEGT OP DESIGNER MAi�qD�RE55 GIiY 21P PMONE <br /> GENEPAL CONTqRGTON MAq qDORE55 CITY ZIP PMDry� LICENSE/ � <br /> Ye Ole Chimne Swee s POBOX 7005 <br /> MECHANICAI CONTflACTOR MAIL ADDRESS �ITY Zlp PXON LICENSE I � <br /> VLUMBING CANTRAGTOR MAIL qDORE55 CITY ZIp PHDNE L�CENSE� <br /> . � <br /> CLR55 OF WOFN <br /> ❑NEW ❑ ADDITION ❑ ALTERATION ❑qEPAIR ❑ DEMOLITION ❑ FENCE ❑SIGN �(WOOD STOVE/FIREPLACE INSERT <br /> VALUATION OF WORN <br /> s <br /> �ESCRI9E WORI( <br /> Install fire lace insert and reline chimne flue <br /> PROPOSE�USE OF BUILOING <br /> Residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> LCGRLDESCRIPTIONOFPHOPEHiY�SHOWBELOWORATTAGMFOUPCOPIES) APPUCATION AND KNOW THE SAME TO BE TRUE AND <br /> CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> LOT_BLOCrc_OF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHER SPECIFIED HEFEIN OR NOT.THE GRANTING OF A <br /> PERMIT DOES NOT PRESUME TO GIVE�UTHORITY TO VtOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERF MANCE OF CONST CTION. <br /> JOB ADDRESS SIG RE,PF Ni pC R AUi 2ED AGENT ORTE <br /> 4625 Colb X � / <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET�TOILEn AIR COND.UNITS— M.P.EA. <br /> BATHTUB REFRIG[RATION UNITS— H.P.EA. <br /> LAVATORY(WASH BASIN) BOILEFS — 4.P. EA. �, <br /> SHOWEF GAS FIRED A.C.UNITS—TONNAGE EA. � <br /> KITCHEN SINN 8 DISP. FORCED AIR SYSTEMS— B.T.U. M EA. <br /> DISNWASHER WALL MEATERS— B.T.U. M <br /> LAUNDRYTRAY UNIT HEATERS— B.T.U. M <br /> CLOTNES WASHER EVAPORATIVE COOLERS I <br /> WATER HEATER CLOTMES DRYERS � <br /> URINAL VENTILATION FAN � <br /> ORINNINCa FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UWT — C.F.M. � <br /> VACUUM BREAKERS S70VE— 1NOOD � <br /> ROOF DRAINS— RAINLEADERS METAL FIREPLACE 8 CNIMNEV ' <br /> SINK(SERVICE— BAR, ETC.) � FIREPLACE INSERT '� <br /> FIEAT PUMP i <br /> __ I <br /> SUB 70TAL S SUBTO7AL { I <br /> PERMIT f PEHMIT f � I <br /> TOTAL FEE f TOTAL FEE S � <br /> SIDE VARD SETBACK SiREET SETBACK qEAR VARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE � <br /> FEE RcCEIPT NO. <br /> USE 20NE LOT AREA VACANT SITE <br /> LYES ,'.NO FEES VAlUA710N FEE <br /> TYPE OF I:ONST. OGGUPANCY GROl1P NO.OF DWELLINti UNITS <br /> BUILDING S <br /> SIZE OF BL�G. NO.OF STORIES MA%.OCG LOAD <br /> PLUMBING <br /> FIREZONE BASEMENT FIRESPFINKLERS MECHANICAL <br /> • FEOUIRED 17 O <br /> YES NO <br /> APPROVALS BY DATE OTHER <br /> 1.ENVIRONMENTAL CMECK U5T PENALTY U.B.C. <br /> 2.BUILDING PLANS SEC.3W�a) <br /> 3.FIREMYDRANT TOTAI �] Q <br /> 4.FIRE PROTECTION SYSTEM PERMIT VqLIDATION p <br /> � 5.GRADING WHEN PROPERLY VALIDATED(IN THIS SP=^E)TH�S I OYI ul.rJ O IT � <br /> e.DPAINAGE Y �) � u p <br /> 7.ENVIRONMENTALIMPACTSTATEMENT O <br /> B.HEALTH OISTRICT M <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY 1':"� U R RE C E I PT `� <br /> �i� !;`,�.K YG U <br /> ADDRF.SS FILE _ � ��� S 4 <br />