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�� <br />(he EeerAreen <br />��r� oF <br />everett <br />GTY HALL 259�8745 <br />� ':ONSTRUCTIOI�' <br />PERMIT PERMIT IvO. �2902 <br />EVERET7,WA98201 ❑ COMBfNATION ❑ BUILDING C7�XMECHANICAL ❑ PLUMBING <br />OWNER MAILAOORE55 CITY LP PHONE <br />r. Darrell J.R. Moffatt 5308 Fairvie�a Avenue Everett 98203 353-2509 ( <br />AFCHITECTORDESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERALCONTRACiOR MAILAODRESS CITY ZIP PHONE LICENSEX <br />MECHANICAL CONTRAGTOR MAIL AOORES:1 CITY ZIP PMONE ULENSE N <br />Same <br />PLUMBING CONTRACTOR MAIL ADORESL CITY ZIP PHONE UC'cNSE p <br />O NEW ❑ ADDITION ❑ ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN }� WOOD STOVEIFIREPLACE INSERT <br />\'4WATION OF WORK � <br />S <br />OESCflIBE WORN <br />install wood stove <br />PFOGOSFO OSE OF B111L01NG <br />LOT _ BLOCK_OF <br />PLUMBING <br />WATER CLOSET (TOI LEn <br />BATHTU9 <br />LAVATORY�WASHEASIN) <br />SHOWER <br />KI7CHEN SINK 8 DISP. <br />LAUNDRYTRAY <br />CLOTHES WASHEH <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN � <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINK (SE9VICE - BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />TGTALFEE <br />OL�G. I NO. OF STORIES <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYORANT <br />J. FIRE PROTEC710N SYS7EM <br />5.GRADING <br />6. DfiAINAGE <br />7. ENVIRON MENTAL IMPACT STl�TEMENT <br />B. HEALTH DISTRICT <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICPTION 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 SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOiATE <br />OR CANCEL THE PROVISIONS QF ANY OTHER STATE OR <br />LOC{� LAW REGULATING I:ONSTRUCTION OR THE <br />PE6(FOAMAN�E OF COWSTRU�TION. <br />OF C�t�fijllCTO�j1%�lyflj�ilZED AGENT UATE <br />FEE NO. TYPE OF EQUIPMENT FEE <br />AIR CUND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H �. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FOFCED AIR SYSTEMS — B.7.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEi.TERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />], STOVE — WOOD i <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUTAP <br />3 SUB TOTAL S / �� <br />f PEHMIT S <br />S TOTAL FEE f 17 50 <br />IEAR YARD SETBACK PLAN CHECK NUMBER PLAN GHECK FEE <br />FEE I RECEIPT NO. <br />VACANT SITE <br />_;YES C-.NO <br />MAX.00Q LOAO <br />VALUATION I FEE <br />BUILDING $ <br />PLUMBING <br />MECHANICAL i� <br />OTHER <br />PENALTY U.B.C. <br />SEC. 3C� (a) <br />TO7AL l� <br />WHEN PROPERLY VALIDATED pN THJS,SPACE) iHl� I$ YIU�i PER�MIT (V <br />h�n� U / 5 �� <br />� <br />N <br />'i'"'iJR R�C�IPT `—; <br />'.�,;:,!� Y'OU <br />ADDRESS FILE <br />I � JA�Y $ !� <br />�1 <br />� <br />