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wa�,.Ir.I.B <br />CRY OF <br />ever�ett <br />259-8745 <br />L ONSTRUCTION '11 <br />PERMIT PERMITNQ ����� <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILOIf1G ] MECHANICAL ❑ PLUMBING ❑ BIGN <br />M'.'L ADW.FSA CITY ZIP PHONE <br />JOHN CLAYBORNE 3416 Federal Everett WA 98201 252-9535 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Valley Natural Gas 11323 Highway 99 Everett WA 98203 355-7730 VALLENG153LI <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE# <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP mow LICENSER <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />CRIBS WORK <br />Install 100M btu furnace <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />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 SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR. AUTHORIZED AGENT. OR OWNER DATE <br />X ";2- 10/1/86 <br />LEGAL DESCRIPTION OF MORE, IY(SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK _ OF <br />JOB ADDRESS <br />3416 Federal <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK a DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ra <br />50 <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC.) <br />NMI <br />METAL FIREPLACE 8 CHIM <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />nn <br />TOTALFEE <br />$ <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL <br />35 <br />50 <br />FIRE SPRINKLERS REQUIRED C1 YES 0 NO <br />INVESTIGATION FEE <br />Sec. 304(e) <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE <br />BY <br />DRIVEWAY PERMIT <br />TOTAL <br />35 <br />50 <br />moult vu InAnnN <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />CrJ <br />�7 <br />N <br />N <br />ADDRESS FILE <br />