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r <br />� <br />'"`E'��TYe�F � ";ONSTRUCTIOR" � <br />everett PERMIT PERMir No. 11966 <br />CITY HALL 259�8745 <br />EVERETT,WA98201 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAILA�DRE55 CITY 21P PMONE <br />R. E. Fisk 4706 103rd Avenue S.E. Everett 98205 568-5�69 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PMONE <br />GE HALGONTNACTOR MAILAD�RESS CITY 21P PHONE LICENSEM <br />�ame <br />MECHANICAL GONTRACTOR MAIL ADDPE55 CITY 21p PHONE LICENSE N <br />PLUMBIHG CONTRACTOfl MAIL AOORE55 CITY ZIP PMONE UCENSE N <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ JEMOLITION ❑ FENCE O SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />s 300.00 <br />�ESCPIBE WORK <br />Reshingle roo£ <br />80POSE0 USE OF BUILDING <br />EGAL OESCRIPTION OF PROPERTY �SHOW BE4 <br />LOT_BLOCN_OF <br />IOB ADDRE55 <br />3307 Federal <br />PLUMBING <br />N0. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY�WASHBASIN) <br />SHOWER <br />KITGHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTH[5 WASHEF <br />WATER HEATER <br />URINAL <br />DRINKING FOUN7AIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />TOTAL FEE <br />NO. <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HVDRANT <br />4. FIRE PROTECTION SVSTEM <br />5. GRADI NG <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTS7A1 <br />8. HEALTH DISTRICT <br />APPL�CATION ACQ BY PLA <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />ATTACMFOURCOPIES) 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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGU'_ATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATUFE OF CONTRgCTOR OR AUTHOflIZEO AGENT OATE <br />i <br />S <br />S <br />'.-'.YES i�:NO <br />NO. OF DWEL <br />RE�UIREG <br />iIVES "'. <br />CHECKED BY I APPR. FOR <br />3 <br />MECHANICAL <br />N0. TYPE OF EOUIPMENT FEE <br />AIR COND. UNITS — 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 SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOIERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />Alfi HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSER7 <br />HEAT PUMP <br />CHECK NUMBER <br />SUB TOTAL S <br />PEHMIT = <br />TOTALFEE s <br />FEE I RECF�PT N0. <br />FEES VAIUATION I FEE <br />BUILDING 5 300.00 10 UO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY SECV303 (a) <br />TOTAL 10 00 <br />PEHMIT VALIOATION <br />WHEN PROPERLY VALIDATED (IN THIG ;P4C�) THIS��O�fj�P�1�IT— ( p <br />p U �� 3J <br />� <br />a"� <br />BY YOUR �ECEIPTr+ <br />-rf,,tir•iK Yo u <br />ADDRESS FILE <br />- 9 unr 8 3 <br />� <br />i <br />