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�`�' �`�JNSTRUCTION � <br /> everetL PERMIT PERMITNO. 17�30 <br /> 259 -8745 <br /> ❑ DEMOLRION ❑ COMBINATION ❑ BUILDING �1 MECHANICAL ❑ PIUMBING ❑ SIGN <br /> ONTlER MAILAD E ITV PrypNE <br /> R. Jorgen Dahl 4928 Glenwoo�"1�ve Everett, W�1 98203 2'�$-9177 <br /> �Rp11TECiORD'_SIGNER MAILADDNf55 CIiV 2iP PMONE <br /> GEIERALCONTq4CTOR MMLADDRE55 CITv 21P PMONE LICENSE� <br /> pN� Owner <br /> MECMANICAL CONTR�CTOR MAIL ADDRE55 CITV 21P PNONE LICENSE r <br /> PLUMBMf :ONTR�CTOH M/ILADORESS CITY ZIP PHpNE LICENSE� <br /> CI.ASS OF WORK <br /> O NEW ❑ ApDITON ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ BUILDIN6 RELOCATION <br /> V�LIUTION OF WO{iN <br /> � <br /> OESCFIBE K � <br /> Instal� free standing stove <br /> HEATSOURCE <br /> ❑ ELECTRICITY ❑ GAS O WOODSTOVE ❑ OTHER <br /> PROPD DU9EOFB I DiNG <br /> $111g�e fam�ty residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> IEWI.0E5CRIPTIONOFP{10PERTY�SMOWOELOWORATTACNFOURCOPIES� C09RECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �or,e�ceK _ ov 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 'i0 <br /> -- VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br /> �p THE PERFORMANCE OF CONSTRUCTION. <br /> ,Y9�0 EG�enwood Ave SIGNA UREOFCONTR CTOf1,AUtM0�12E0AGENT.OROWNER pATE <br /> z 1��(�Q.i ��zs�s� <br /> PLUMBING MECHANI <br /> NO. T'PE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER ClOSET(TbII.ET) A/C—�/HN�LG UNITS—HP. <br /> BATHTUB REFRIGERqTION UNITS—H.P.EA. <br /> LAVATORV(\VASH BASIN) BG�LERS—BSLIH.P. <br /> SMOWER GAS FIRED A�C.UNITS—B.T.U. <br /> NITCNEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISMWASHEF WALLHEATER;i-9.T.U. M <br /> lAUNDRYTRAV UNITHE4TEf'.S—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVECOOLERS <br /> URINAL CWTHES DRVERS <br />' DRINKING FOUNTAIN VENTIIATION FAN <br /> FLOOR DRAIN RdNGE HOOD <br />� BACHFLOW PREVENTERS WATER HEATER <br /> ROOFDRAINS—RAINLEADERS 1 WOOOSTOVE <br /> SINK(SERVICE—BAR.ETCJ kETAL FIREPLACE 8 CHIMNEY <br /> FIREPLACEINSERT <br /> NEAT PUMP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> SUB TOTAL s sue roT�� 30 00 <br /> PEHMIT f PEflMIT - - <br /> TOTALFEE f TOTALFEE <br /> FNC�NT SETBACN REAR SETORCK SIOE SETORf.K p�qN CHECK NUMBER FEE RECEIPT NO. <br /> USEZONE LOTAqEA yqCANT4ITE <br /> ❑ves ❑No FEES VALUATION FEE <br /> TYPtC°CONST. OCCUPANCYGPOUP NOOF�WELLINGUNIiS BUIIOING S <br /> PLUMBING <br /> SIZE OF BLDG NO OF STORIES MAX OCC.LOAD <br /> MECHANICAL 3O OO <br /> INVESTIGATION FEE Dl.��le�2: 7FM OOORH38:8 :4=kt��t <br /> FIRE SPRINKLERS REOUIRED VES NO i <br /> STATE BUILDING SUFiCHARGE .� <br /> STATEENEflGVSURCHARGE MECH 'D O.DO <br /> PPPIICFTION ACC BV PLNNS CHECNEO BY APPR fOR ISSUANCE OY , � <br /> DRIVEWAY PERMIT <br /> M.M. TOTAL O OO <br /> PERMIT VALIDATION <br />'I WHEN PROPERLV VALIDATED(IN THIS SPACE)THIS IS VOUR PERMI�' <br /> i v <br /> M <br /> CD <br /> � <br /> c— <br /> I ;,U . . . ., i '. <br />