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�r "� <br /> th.� k�crrerern . J������������ <br /> everett PERMIT PERMIT NO. 127OJ <br /> CITV HALL 259�d]d5 <br /> eveaerr wn eezui ❑ COMBINATION U BUILDING � MECHANICAL ❑ PLUMBING <br /> OWNER MALL ADDRESS GITV Ziv VHONE � <br /> BURLINGTON NORTHERN 2900 Bond Street Evrt 98201 <br /> ARGHRECT OR DESIGNER MAIL AODRE55 CITY ZIP PMONE <br /> GENERPI CONTRACTOR MAII AD�RESS GITV ZIP PHONE LIGENSE N <br /> MEGHRN�CAI CONTRACTOR MAIL ADDRE55 CITY ZIP PMONE LICENSE M <br /> Blythe Plumbing and Heating 2201 Humboldt Bellingham WA 98225 733-7810 � <br /> � PWMBING CONTRACTOR MAIL AODRESS CITY ZIF PMONE LICENSE X <br /> CLASS OF WOPK <br /> �HEW ❑ ADDITION ❑ ALTERATION ❑REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN O WOOD STOVEIFIREPLAGE INSERI <br /> vpLUATION OF WORN <br /> S <br /> DESCRIBE WORK <br /> Install boiler - <br /> caoaoseo usE oc ew�owc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Commercial <br /> APPLVCATION AND KNOW THE SAME TO BF TRUE AND <br /> �ecn�oescaiPnor�oFaaovearv�sHowae�owoanrracHcouacoaies CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH <br /> �or_e�ocK—oF WHETHEA SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERMIT DOES NOT FRESUME TO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CONTRPCTOR OR AUTHORIZEO AGENT 11/16�EH 3 <br /> JOQ,qQIjP�ssBond StT22t X <br /> LyV <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) AIR CONO.UNITS — H.R EA. <br /> BATHTUB REFRIGERATION 11NITS — H.P. EA. <br /> LAVATORY(WASHBASW) 1 BOILERS— H.P. EA. 84O OOO �7tU IS OO <br /> � SHOWER GAS FIFED u_G. UNITS —TONNAGE EA. <br /> KITCHENSINK&DISP. FORCEDAIFSVSTEMS— BT.U. MEA. <br /> DISHWASHER WA'.L HEATERS— BT.U. M <br /> IAUNDRY TRAV UNIT HEATEFiS— B.T.U. M <br /> CLOTHES WASHER EVAPOFATNE COOLERS � <br /> WAtER HEATER CLOTHES DRVERS <br /> URINAL _ VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE MOOD <br /> � FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE—WOOD <br /> ROOF DRAINS— RAINLEADERS METAL FIREPI.ACE 8 CHIMNEV _ <br /> SINK(SERVICE— BAR, ETC.) FIREPLACE INSEPT <br /> HEAT PUMP <br /> ' SUB TOTAL s SUB TOTAL f 1 S O <br /> PEPMIT f PERMII� S O O <br /> TOTALFEE f TOTAL FEE f S O <br /> PLAN CHECK FEE <br /> SIDE YARD SETBACK STREET SETBACK REAR VARD SETBACK PLAN CHECK NUMBER qECEIPT NO. <br /> FEE <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> VES NO <br /> TVPE OF CONST. OCWPANCV GROUP NO.OF DWELLING UNITS _ <br /> BUILDING 5 <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC. LOAD — <br /> PLUMBINCa <br /> � <br /> 1 — <br /> '-� FIRE.-ONE BASEMENT REQUSRED KLERS MECHANICAI S O <br /> VES NO <br /> pPPROVALS BY DATE <br /> OTHER <br /> Uf1C <br /> i.ENVIRONMENTAI CHECK LIST _ PENALTV SE1:.303(a) <br /> 2.BUILDING PLANS � TOTAL Z S O <br /> 3.FIRE HVDRANT <br /> ' 4.FIRE PROTECTION SVSTEM VERMIT VALIDATION <br /> WHEN PROPERLY VAVDATED(IN THIS S�PgCI)THIS1S�V(�U�PF�R��T— `-� I <br /> S.GRADING 9 � a L C <br /> 8.DRAINAGE r <br /> 7.ENVIRONMENTAL IMFACT STATEMENT �v <br /> B.HEALTHDISTRICT y�� '�..) R RECEIPT `'�` <br /> qPPUCATION ACC.BV PLANS CMECKED BY APPR.FOR ISSUANCE BY '� • !�?�'� Y O U <br /> l 6 �v 8� <br /> ADDRf.S` FILF <br /> ! <br /> • � <br />