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CITY OF( rONSTRUCTION ; eV :9�-gR n, PERMIT PERMIT NO. q 1 8122 <br />❑ DEMOLITION ❑ COMBINATION ❑cBUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SION <br />OWNERChjWUII MAIL ADDRESS CITY ZIP PHONE <br />Jerry 411moohdaUl 610 Colby Everett 98201 259-1578 <br />ARCHITECT OR DESIGNER MAIL APDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />LICENSE. <br />Everett Bldrs. Inc. 5606 Evergreen Way Everett 98203 353-7161 EVEP.EB*301YH <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION EJALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />f 2454.00 <br />Tear off and Reroof (Comp 17) <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 'O BE TRUE AND <br />CORRECT. ALL PROVISIONS 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 />FERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SCNATU FF CONTRgCTOR. 1H0 IZEp AG ENT, OR OWNER DATES <br />X VNL!/1�. 4 7G ' p <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK _ OF <br />JOB ADDRESS <br />610 Colby Ave. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_TYPE <br />A/C — A/HNDLG UNITS -- HP. <br />BATHTUB <br />REFRIGERATION UNITS — HP EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T U./H. P. <br />SHOWER <br />GAS FIRED A C UNITS — B T.U. <br />KITCHEN SINK d DISP. <br />FORCED AIR S°STEMS — B.T U. M EA <br />DISHWASHER <br />WALL HEATERS — B T U. M <br />LAUNDRYTRAY <br />UNIT HEATERS —B.TU M <br />CLOTHES WASHER _ <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS -- <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EAHAUSTFAN <br />SUB TOTAL <br />f <br />SUB TOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />_ <br />FEES <br />V U 10 <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />E 24 A <br />5 <br />PLUMBING <br />10001E121 <br />- <br />SIZE OF BLOG <br />NO. OF STORIES <br />MAX OCC LOAD <br />MFCHANICAL <br />F. C <br />SIRCH9 <br />` `O <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />Ito" aq Mq <br />STATE BUILDING SURCHARGE <br />.5 <br />STATE ENERGY SURCHARGE <br />CHECK I1: <br />3.00 <br />APPLICATION ACC BY <br />S.EI. <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE <br />BY <br />DRIVEWAY PERMIT <br />TOTAL <br />55 <br />50 <br />"'HEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />N <br />N <br />a -- <br />GO <br />c— <br />ADDRESS FILL <br />