Laserfiche WebLink
the Eivrgirom <br />CITY OF rONSTRUCTION q <br />everett PERMIT PERMITNQ;- 79�1 <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING f7 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />D.W. & C.R. Hajek 6026 Dexter Ave Everett, WA 98203 355-1942 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY LP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MML ADDRESS CITY ZIP PHONE LICENSE <br />ILN.. air omen <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />$70. 00 <br />DESCRIBE WORK <br />Install clay liner & ikich t1limYlle in existing cr.imney for trashburner/woodstove <br />HEAT SOURCE <br />rT ELECTRIL.FY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Single family residence <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />LEGAL DESCRIPTION OF PROPERTY(SIIOW BELOW OR ATTACH FOUR COPIES) <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT _ BLOCK _ OF <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY Oi-HER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGN RE OF CO TRACTOR. AUTHORIZE AGEN OR OWNER GATE <br />JOB AMBLES <br />X lAr 3/16/87 <br />6026 Dexter Ave <br />GOL o- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A C - A,HNDLG UNITS - H P. <br />BATHTUB <br />REFRIGERATION UNITS - H P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H P. <br />SHOWER <br />GAS FIRED A C. UNITS — B.T U <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B T U M EA <br />DISHWASHER <br />WALL HEATERS —BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESORYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER - <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSIFAN <br />1 <br />woodstove insert <br />3C <br />00 <br />SUBTOTAL <br />S <br />SUBTOTAL00 <br />PERMIT <br />$ <br />PERMIT <br />TOTALFEE <br />S <br />TOTALFEE <br />3O <br />00 <br />FRONT SETBACK <br />REAR SETBACK <br />smESE1BACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑YES ❑No <br />BUILDING <br />$ <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />./ !O! 11•J <br />H H 4 4 <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />UDDD179D7 <br />MECHANICAL <br />30 <br />UO <br />INVESTIGATION FEE <br />L4 Y <br />i <br />C_SocR304(B) <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED LIVES ❑ NO <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />30 <br />00 <br />M.M. <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) IHIb IJ TuuH renml I <br />t� <br />ADDRESS FILE <br />