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r <br />M <br />� <br />� <br />rae ee�,xme� <br />C�TV OF <br />everett <br />CI7V HALL 259�8745 <br />' �ONSTRUCTIOP' <br />PERMIT PERMIT N0. 12703 <br />EVEREfT,WA90201 ❑ C�)MBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING <br />OWNER MAILAOOflESS GITY ZIP PHONE <br />Randy Lervold 6123 Evergreen Way Everett 98203 355-5510 <br />ARCMITECT OR �ESIGNEFi MAIL A�OPE55 CITY ZIP PNONE <br />GFNEflALGONTRAGTOfl MAILAODRESS CIiY 21P PMONE LICENSEI <br />MECHANICAL CONTFALTOR MAIL ADDRESS CITY 21P PHONE LICENSE I <br />Same <br />PLUMBING CONTRALTOR MAIL AOCRESS LITY i Z�p PHONE LICENSE � <br />❑ NEW ❑ ADDITION ❑ ALTERATION O FEPAIR ❑ DEMOLITION ❑ FENCE O SIGM ❑ WOOD STOVEIFIREPLACE INSERT <br />f <br />LOT_BLOCK_OF <br />6123 Evergreen Way <br />PLUMBING <br />TYPE OF FIXTURE OR <br />BATHTUB <br />LAVATORVIWASHBASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />LAUNORY7RAY <br />CLOTHES WASHER <br />WATFR HEATER <br />URINAL <br />DRINKING FOUNTAiN <br />FLOOR DRAIN <br />VACUUM BflEAKEFS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />PEpM1T <br />TOTAL FEE <br />OF <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLqNS <br />7. FIPE HYDRANT <br />4. FIRE PROTECTION SVSTEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEn�TH DISTRICT <br />APPUCATIGN ACC. BY "LANS ChIE� <br />-_z <br />I HEREBY CERTIFY THAT 1 HA\'E READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />COFlRECT. ALL PROVISIONS C� LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE <br />OR CANCEI THE eROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REG�(i.pTING CONSTRUCTION OR THE <br />aGENT <br />MECHANICAL <br />FEE N0. TYPE OF EOUIPMENT <br />0.iR CON�. UNI7S — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYS7EMS — B.T,U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLO7HES DRYERS <br />], VEN7IU.TION FAN <br />� P.A;:�e HOOD <br />F!R HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLPCE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />� <br />S <br />5 <br />REAR VA(iD SETI <br />VACANT SITE <br />GYES uN0 <br />NO.OF �WELLIN <br />MAX. 000. LOAD <br />BY I DATE <br />FOR ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />SUB TOTAL S <br />PERM�T S <br />TOTAL FEE S <br />PLAN CI <br />FEE <br />VALUATION <br />S <br />�a1 <br />DATE <br />11/16/83 <br />FEE <br />PECEIPT NO. <br />FEE <br />TOTAL I I li I SO <br />WH N' PROPERLY� ALIDA7ED pN TI�IS��4FSE) THI,�I� Ybl� F�IQAIt� (�� <br />Cl <br />��� <br />1':'�UR RECEIPT ��; <br />;;-1^�i�v YOU <br />ADDRESS f-ILE <br />i � ���y 83 <br />1 <br />� <br />1 <br />✓ <br />