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fhe Erergreen <br />CITV OF <br />everett <br />CITY HALL 259�8745 <br />�- �ONSTRUCTIO� - <br />PERMIT PERMIT NO. 12279 <br />EVERETT, WA 98201 ❑ CUMBINATION ❑ BUILDING ❑ MECHANICAL X� PLUMBING <br />OWNER MAII AOf16ES5 CITY ZIP PMONE � <br />L. ANDERSON 3920 federal Everett WA 98201 <br />ARCHITECT Ofl OESIGNEF MAIL ADDRESS CITY ZIP PHONE <br />GENERAI CONTRACTOR MAIL ADDRESS CITY ZIP PNONE UCENSE M <br />S& M #7 117th PL SE Everett WA 98204 353-6210 <br />MECHANICAL GONTRAGTOR MAIL AODRE55 CITY ZIP PMONE LICENSE � <br />SMSEPSD274M0 233 O1 <br />PLUMtlING CONTRACTOP MAIL AU�RESS pTY ZIP PHONE LICENSE Y <br />❑ NEW ❑ AODITION ❑ ALTERATION XXREPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />OF <br />S <br />DESCRIBE WORK <br />Replace water line <br />PROPOSEO USE OF BU�.°es i d enc e <br />LOT_BLOCK_OF <br />)OBADDRESS 3920 F2d2Pd1 <br />PLUMBING <br />TYPE OF FIXTI <br />WATER CLOSE7 (TOI LEn <br />BATHTUB <br />LAVATORYIWASH BASI� <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASH=R <br />LAUNDRYTRAY <br />WATER HEA7ER <br />URIN4� <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINKISERVICE - BAR,ETC.) <br />ITEM <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />� <br />APPHOVALS <br />1. ENVIflONMENTAL CHECK LISi <br />2. BUILOING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />7. ENVIROI <br />9.HEALTH <br />ACC. BY <br />BY <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 />?ERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />UR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAU/ REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNPTURE OF CONiRACTOR OR AUTMORRED AGENT OATE <br />MECHANI�`iliL <br />FEE NO. TYPE OF EOUIPMENT <br />AIR COND. UNI75 - 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 HEATEFS - B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DFiYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT - QF.M. <br />STOVE - WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />n n.. HEAT PUMP <br />� <br />S <br />f <br />REAR YA(iD 5 <br />VACANT SITE <br />.:YES :�.NO <br />NO. OF DWEL <br />MAX. OCC. LC <br />FIRE SPRINKI <br />REOUIRED <br />::YES :-:NO <br />er <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />SUB TOTAL S <br />PEHMIT f <br />1�TALFEE S <br />PLAN C <br />FEE <br />VnLUATION <br />b <br />FEE <br />RECEIPT NO. <br />FEE <br />PENALTY SEC.3031a) <br />TOTAL 5 00 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN TIiI�S�9C�) THIS��Q�I}Pfj(iMIT__ � <br />6 U7 UU <br />N <br />N <br />BY YOIi R RECEIPT� <br />TI-If�NK YOJ <br />29,�.83 <br />0 <br />� <br />� <br />