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r <br />�hr Ein�erern <br />everett <br />CITV MALL 259�67A5 <br />EYERETT, WA 982�1 <br />� ^,OIVSTRUCTIOf�� <br />PERMIT <br />❑ COMBINATION XY� BUILDING ❑ MECHANICAL <br />PERMIT N0. 12�33 <br />❑ PLUMBING <br />9WNEH IAA4 ADORE55 GITY ZIP PMONE <br />DONALD WELLS 918 COLBY EVERETT WA 98201 259-6345 <br />0.RGM�lEGi OR OESiGNEii Mqi� qDOFE55 CrtY Z�P PH�,NE <br />GE�IERRI CONiRRLtON fdelL AODRE55 CITY ZIP PMONE IICENSE � <br />EVERETT BLDRS 5606 Evergreen Way Everett 98203 353-7161 <br />MELNANICRL LUNiPALTOF MRIL ADORE55 GIiY Zlo PMONE 4CENSE 1 <br />PWMBMG CONTR/CTOR MAIL ADDNE55 p7Y ZiP PMOHE LICENSE � <br />❑ NEW ❑ A�D:7lON � AL7ERATION ❑ REPAIR ❑ OEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VAWATION OP WORK <br />=4575.00 <br />�[5-RiBE WORK <br />yReroof residence with shakes <br />ence <br />IOT�iLOLK�OF <br />Por 26 <br />918 Colby <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITFM <br />W ATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORY (1NASN BASIN) <br />SHOWER <br />KITCNEN SIHK 8 D15P. <br />DISNWASMER <br />LAUNDRYTRnY <br />CLOTMES WASMER <br />WATER HEATER <br />URINAL <br />DRINKING FOUN7AIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />PENMIT <br />TOiAI FEE <br />OF <br />APPPOVALS <br />1. ENVIqONMENTAL CHECK LIST <br />2.8UILDING PLANS <br />1 3. FIPE HVORANT <br />` d. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. OfiAINAGE <br />IMPAC75TATEMENT <br />B.MEALTH DISTHICT <br />APPLICATIOH ACC. <br />I HEREBY CERI-IFY THAT I HAVE READ AND EXAMINED THIS <br />FOURCOPIES� APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THiS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIFD HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES Y0T PIZESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL 'i-HE P��OVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW H�VULATING CONSTRUCTION OR THE <br />PERFO ANCE�OF CONSTflUCT10N. <br />SiGNAIUR�F CONTp�C10R OF AUjHO/IIZEO AGEN7 pATE <br />FEE <br />�S <br />REAR VARD SETE <br />VACANT SITE <br />YES . NO <br />NO. OF DWELLIN <br />MAX.00C.LOAD <br />X <br />AIR COND. UNITS — H.P. [A. <br />flEFRIGERATION UNRS — H.P. EA. <br />BOILEPS — H.P. EA. <br />GA$ FlRED AA. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. Id EA. <br />WALL HEATERS — d.T.U. M <br />UNIT NEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DflYEflS <br />VENTILATION PAN <br />RANGEHOOD <br />AIR HANDUNG UNIT — C.F.M. <br />S70VE — WOOD <br />METAI FIREPLACE 8 CHIMNEY <br />FIREPLACEINSEFT <br />PLAN CNECK NUMBER <br />FEES <br />6WLDING <br />PLUMBIN� <br />MECHANICAL <br />VES NO <br />BV OATE OTHER <br />PENALTV <br />TOTAL <br />SIiB TOiAL f <br />PERMIT f <br />TOTAL FEE S <br />PLAN CI <br />FEE <br />VALUATION <br />$ 4575.00 <br />U.B.C. <br />SEC. 30J lal <br />ti/1 <br />FEE <br />RECEIP7 NO. <br />FEE <br />50 <br />PEPMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE� THIS IS YOUR PERMIT (Y� <br />P.DDRE55 FIIE <br />C� <br />75�3 aoso.so _� . <br />1'�UR �FCEIPi <br />T�� 1,�lt; YO U <br />