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�'"� Up•f.���iAi�r�i <br /> r,` ��T�oF �� _:�� ,�-.�ON�TRUCTIO��, �;�, <br /> �� everett `"�` NERMIT PERMIT NO. 15746 � <br /> ��' pTY HALL 2548715 � <br /> � EVEREtt,WA9S201 � COMBINATION ❑ BUILDING C� MECHANICAL ❑ PLUMBINQ <br /> 4' <br /> ?� OWNEX M�IL�DDRESS CITY 21P PHONE <br /> �h <br /> ;; Robert E. Perin 451:' Forest Dr. Everett 98203 252-0465 ; <br /> �� HIT C O ION MnIL AD�RESS CITY ZIP PMONE • i <br /> i <br /> '` I <br /> '� N �L CONTR�CTOR MAIL AUDqESS CITY 21P PXONE LICEf18E I <br /> MECN�NICIILCONTP�GTOR IAAILAODRESS CITY 21P PNONE UCEN6E1 <br /> :� <br /> PLUMBINO CONTMCTOfl M�IL AO�flE55 CITY ZIP PHONE UCENSE I <br /> CUSS OF WORK <br /> v ❑NEW ❑ ADDITION ❑ ALTERATION ❑REPAIR ❑ DEMOLITION ❑ FENCE O SI(3N fI WOOD STOVFJFIREPLACE INSERT <br /> VAW�TION OF WORK . <br /> f • <br /> DESCNIBE MIORK <br /> '; Change fzam o!�en type to air tivht wood stove <br /> . Morono ue[oc�m�.oieo -- <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Sinalo familv roai.�e APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> � LEOA DESGfl1GTION PROPER Y�SNOWBELOWORATTACHFOURCOPIES) CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> LOT_�BLOCK_OF 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 PFOVISIONS OF ANY OTHER STPTE OH <br /> ' - LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE O 0 STRUCTION. <br /> JOB�UORESS SIGN OF N TO OR A THORRED AGENT DATE <br /> 4512 Forest Dr. X ^� <br /> PIUMBINO MECMANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EUUIPMENT FEE <br /> WA7ER CLOSET�TOILEn AIR COND.UNITS—H.P. EA. <br /> � BATHTUB <br /> REFRIGEFATION UNITS�-H.P.EA. <br /> LAVATORYIWASHBASIN) BOILERS—H.P.EA. <br /> SHOWER GAS FIRE�A.C.UNITS—TONNAGE EA. <br /> KITCNEN SINK 6 DISP. FORCED AIR SVSTEMS— B.T.U. M EA. <br /> DISHWASHEH WALL HEATEHS— B.T.U. M <br /> LAUNDRYTHAY UNIT HEATERS— B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOiHES DRYERS <br /> UHINAL VENiILAT10N FAN <br /> DRINKINO FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE—WOOD <br /> ROOF DRAINS— RAINLEADERS METAL FIRFPLACE 6 CHIMNEY <br /> SINK�SERVICE— BAfl,ETC.) FIREPLACE INSERT <br /> HEAT PUMP <br /> SU8 TOTAL S SUB TOTAL S <br /> PEqM1T i PERMIT S <br /> TOTAL FEE f TOTAL FEE � 17 S <br /> SIDE YAHDSETBACK STREETSETBACK REAR YAqD SE7BACK PLAN CNECK hUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LCT APEA VACANT SITE <br /> ❑YES ❑NO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP N0.OF DWELLING UNITS <br /> � BUILDING S <br /> SIZE OF 8LD(:. NO.OF STOPIES MAX.OGC.LOAD <br /> PLUMBING <br /> FIREZONE BASEMENT FIFE SPRINKLERS MECHANICAI <br /> P.EOUIRED ].� 50 <br /> ❑YES ONO <br /> AVPNOVALS BY DATE OTHER <br /> 1.ENVIRONMENTAL CHECK LIST PENALTY U.B.C. <br /> 2.BUILDINO PUNS SEC.303(a) <br /> 3.FIHEHYDRANT TOTAL 17 50 <br /> �.FIRE PROTECTION SYSTEM PEPMIT VALIDATION <br /> S.QRADINQ WHEN PROPERLY VALIDATF_r,(IN TH�)THI$�'81IY�q�PAIT` !,Q'� <br /> ,D`4I� '�' ,!�. <br /> 8.DRAINAOE <br /> 7.ENVIRONMENTALIMPACTSTATEMENT <br /> r- <br /> B.HE4LTHDISTRICT y'� 5.�1��7`� �r�-����r� <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY <br /> �� � l,�;�+�:rY�i�� <br /> - � 1��P��'��� , <br /> ADDRESS FILE _ <br /> ��.�r;•c.... . �� �t�.�. i.. .:s .r ' +i3. <br /> .,r <br />