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rhe E��ergreen <br />CITY OF <br />e�verett <br />CI7Y HALL 259•8745 <br />EVERETT, WA 98207 <br />� -��� -':ONSTRUCTIOP' <br />PERAAIT <br />❑ COMBINATION ❑ BUILDING � MECHANICAL <br />PERMIT NO. 16668 <br />❑ PLUMBING <br />OWVER MAILADDRESS CITY ZIP PHONE <br />Larry M. Siep 5610 Fleming Ecerett, WA 98203 347-3696 <br />ARCHITECT OR DESIGNER MAIL nODRE55 CITY 21P PHONE <br />4EHERAI LONTRACTOfl MAIL AOORESS CITY ZIP PMONE LICENSE N <br />MEI:HANILAL CONTRACTOfl MAIL AOORESS CITY 21P PHONE LICENSE Ir <br />Russell ConRtruction 9115 - 49th Ave W. Mukilteo, WA 98275 RUSSELC154KM <br />PLUMBING CONTRACTOR MAIL A�DRE55 CITY 21P PMONE LIGEN°E N <br />IV^^� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN � WOOD S70VFJFIREPLACE INSERT <br />OF WOFK <br />5 <br />OESCFIBE WORK <br />Install wood stove insert & line chimney <br />PROPOSEO USE OF BUIL�ING ,I <br />Single faznily residence <br />LOT_BLOCN_OF <br />PLUMBINO <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILE7) <br />BATHTUB <br />SHOWER <br />DISP. <br />LAUNDRYTRAY <br />GLOTHES WASHER <br />WATER HEATER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />VACI�UM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINK (SERVICE - BAR, ETC.) <br />SUB TOTAL <br />FEE <br />FIRE <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />7.ENVIRONMENTALIMPACTSTATEN:NT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />M.M. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME i0 BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS ANG 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 AUTHORITYTO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGUL.dTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNA�Tyj�E OF CONTRACTOfl Q9 A HORIZEO AGENT DATE <br />Y i7CQN�. M'1 . ��/ � /l�b 6/12/86 <br />FEE NO. TYPE OF EOUIPMEN7 <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. ti1 <br />UNIT HEATERS - B.T.U. M <br />EVAPORATIVE COOLEFiS <br />CLOTHES DRYERS <br />VENTILATION FAN _ <br />RANGEHOOD <br />AIR HANDLING UNIT - C.F.M. <br />STOVE - WOOD <br />METAL FIREPLACE & CMIMNEY <br />1 FIREPLACEINSERT <br />HEA7 PUMP <br />� <br />f <br />s <br />REAR YARD SE7B <br />VACANT SITE <br />C;VES -'NO <br />NO. OF DWELLIM <br />MAX.00C.LOAD <br />SU9 TOTAL <br />PEFMIT _ <br />TOTAL FEE <br />(NUMBER F <br />FEE <br />FEES VALUATION <br />BUILDING <br />PLUMBING <br />MEGHANICAL <br />OTHER <br />PENALTY <br />a <br />SEC. 303 <br />FEE <br />� <br />S <br />S <br />DHECK FEE <br />RECEIPT NO. <br />FEE <br />45 00 <br />TOTAL I � 4SI00 <br />PEHMIT VALIDATION �1�l ��p� n�tfy r�ppYt�t7� <br />YJHEN PROPERLY VALIDATED (IN'fh�l6^JrM�Pl9`�31�Y1�� � <br />i1000�6668 CD <br />�.� �.� :..0 <br />�� �J.� r-� <br />ADJRESS FILE <br />� <br />2 <br />0 <br />-� <br />c <br />m <br />., .-. <br />�� <br />.+ � <br />�' m <br />v <br />m� <br />-a c <br />03 <br />m <br />S -=-1 <br />m <br />M <br />C <br />r S <br />H H <br />-� N <br />< <br />� <br />O � <br />T �-i <br />2 <br />m �-. <br />N <br />O <br />or <br />�m <br />C VI <br />; N <br />m <br />� r <br />. m <br />a <br />a <br />2 <br />a <br />z <br />� <br />S <br />M <br />N <br />2 <br />O <br />--1 <br />C') <br />m <br />