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the Lrrr�rren <br />� ,,�: <br />everett <br />QTV MALL 255�8745 <br />EVERETT WA 98207 <br />� �on�s-rRucT�or• <br />PERMIT <br />❑ COMBINATION ❑ P�UILDING �] MECHANICAL <br />PERMIT N0. 1545� <br />❑ PLUMBING <br />CWNER MAILAD�d1E55 GiTV ZiP PNONE <br />GARY L. DAVIS PO BOX 150s EVERETT WA 98206 252-3114 <br />ARCHITELT OR OESiGNER M44 ADORE55 G�TY ZiP PHONE <br />GENERAL CGNTRALTOF A1AIL PDDRESS GiY ZIP GNONE LILENSE I <br />MEChANIGPL GONTNAGTOF MAIL ADDRE55 CITY 2iP PHONE ULENSE � <br />NATURAL GAS [QUIPMENT 1625 E. Marine View Drive Everett WA 98201 258-2441 <br />PWMBING GONTRACiOR MAIL ADORE55 GITY 2iP PMONE LICENSE • <br />S <br />L�(NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN <br />OF WORK <br />Gas pipe to new gas furnace <br />Residence <br />LOT _BLOCN _Oi <br />J�B A�ORESS <br />6019 Colby Avenue. <br />PIUM,BING <br />TYPE OF FIXPURE OR ITEM <br />WATER GLOSET (TOILEn <br />BATHTUB <br />LAVATORY (JJASM BASIN) <br />SHOWER <br />HITCMEN SINN 8 DISP. <br />DISHINASMER <br />LAUNDRYiRPY <br />CLOiHES WAuHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNiAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />PERMI7 <br />TOTAL FEE <br />APPROVALS <br />L ENVIROpMENTAL CHECK LIST <br />2.OUILDING PLANS <br />3. FIRL NVDFANT <br />4. FlfiC- PROTECT:ON SVSTEM <br />5. GNADING <br />6. �RAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />B.HEALTN DISTRICT <br />APPLICATION ACC. BY PLANS CHE <br />3 <br />f <br />S <br />.-:VES �..NO <br />NO <br />DATE <br />APPR.FORISSUANCE <br />❑ WOOD STOVE/FIi7EPLACE INSERT <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED WITH <br />WHETHER SPECIFIED NEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY (>THER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOf}�JIANCE OF CONST������nnnRUCTION. <br />SIGNATUq�pF C0t1Nj/CLOR OR AVT�i12ED AGGNT OiT[ <br />N0. <br />AIR COND. UNITS — H.P. EA. <br />PEFRIGERATION UNITS — M.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIREO A.C. UNITS — TONNAGE EA. <br />FORCE� AIR SYSiEMS — B.T.U. M EA. <br />WALL HEATEPS — B.T.U. M <br />UNIT HEATEFS — B.T.U. M <br />EVAPORATIVE COOL'cR5 <br />CLOTMES DRYERS <br />VENTILATION FAN <br />RANGEHDOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSER7 <br />MEAT PUMP <br />PLAN CHECK <br />BlI1LDING <br />PLUMBING <br />MECHANICAL <br />OTMEfl <br />PENALTY <br />SUBTOTAL S <br />PEPMIT S <br />TOTAL FEE f <br />PL/+N C <br />FEE <br />VALUATION <br />f <br />U.B.C. <br />SE�. 30J la1 <br />FEE <br />RECEIPT h0. <br />FEE <br />TOTAI I I I �� <br />PENMIT VALIDATION <br />WHEN PROPERLY VALIDATED UY THIS=SP�AOE�) 7HIS �5 Y�OiR�PEO OT'� <br />� [� W S <br />� <br />� <br />}� i <br />�jl_.�.���� i�1.�1C��f"1� � <br />1!'„�,NK YOtJ <br />ADDRCSS FlL[ <br />1 � �_i� 5 5 <br />z <br />0 <br />1 <br />c� <br />m <br />... .. <br />-i � <br />.. -� <br />V1 S <br />m <br />co <br />mo <br />n <br />-i c <br />O 3 <br />m <br />�z <br />2 -i <br />m <br />Q 2 <br />a -+ <br />r S <br />-i N <br />< <br />T <br />O .� <br />� 3 <br />-� m <br />x <br />m N <br />O <br />or <br />�m <br />C N <br />3 tn <br />m <br />Z f7 <br />-i r <br />• m <br />a <br />� <br />� <br />S <br />D <br />2 <br />--�1 <br />2 <br />N <br />Z <br />O <br />� <br />n <br />m <br />