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`'"�`"��TY°� ' CONSTRUCTIC?"'� <br />everet� PERMIT PERMIT NO. <br />CITY HALL 259�07C5 <br />EVERETT,WA9ffi07 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL AODRE55 dTY ZiP PHONE <br />Robert Loesche 5008 Dogwood Drive Everett WA 96203 259-0720 <br />ARCMITECT OR OESIGNER MAIL ADOFESS CITY ZIP PHONE <br />GENERAL CONTRAGiOR MAIL ADDRESS CITY 21P PHONE UCENSE � <br />Self <br />MECHANICAL GONTRRCTOF MAIL AD�RE55 GITY ZIP PHONf LIGENSE • <br />PLUMBING CONTRAGTOR MAIL AD�RESS dTY ZIP PNONE JCENSE / <br />O NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVFJFIREPLACE INSERT <br />S 700.00 <br />Replace roof (asphalt shingles) <br />Family Dwelling <br />LEGAL OESCRIPTION OF PROPERTY �SMOW BELOW OR ATTpLH FOUP COPIES� <br />LOT_BLOCK_OF <br />5006 Dogwood Drive <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY�WASHBASIN) <br />SMOWER <br />KITCHEN SINK 8 DISP. <br />LAUNDRVTRAY <br />CLO7HES WASHER <br />WATEFi HEATER <br />URINAL <br />URINKING FOUNTAIN <br />fLOOR ORAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK ISERVICE — BAR, ETQI <br />PEHMIT <br />TOTAL FEE <br />1. ENVIRONMENTAL CHECK L15T <br />2. 9UILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SVSLEM <br />5. GRADING <br />6.DHAINAGE <br />IMPACTSTATEMENT <br />B. HEALTH <br />MD9 <br />FEE <br />�S <br />REAR YARD SETE <br />VACANT SITE <br />:-YES '.:NO <br />NO. OF DWELLIN� <br />MA7f. OCQ LOAD <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 HEREtN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERF�O�A4ANGE OF CONSTRUCTION. <br />SIGN EOF,S�NTijnCTORORAUTMOR2Fp/GENT / DATE <br />X ( �a <br />MECHANICAL <br />NO. <br />AIR COND. UNI7S — H.P. EA. <br />REFRIGERATION UNITS — M.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNI7S — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. A1 EA. <br />WFLL HEATEflS — B.i.U. !A <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLEFS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL PIREPIACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />BUIL�ING <br />PLUMBING <br />MECHANICAL <br />OATE OiHER <br />BY IAPPR.FORISSUANCE BY <br />L.C. <br />PENALTV <br />SUB TOTAL S <br />PERMIT 5 <br />TOipL FEE S <br />PLAN CI <br />FEE <br />VALUATION <br />s 700.00 <br />U.B.C. <br />SEC. 3091a1 <br />7 <br />FEE <br />RECEIP7 NO. <br />FEE <br />13 <br />70TAL I I <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDA7ED (IN THIS SPACE) THIS IS VOUR PERMIT <br />ADDRESS FILE <br />M <br />� <br />0 <br />Ln <br />� <br />z <br />0 <br />-i <br />� <br />m <br />.� .. <br />-� -n <br />�� <br />�m <br />0 <br />mo <br />O 3 <br />-� z <br />x -a <br />m <br />.. <br />O Z <br />C <br />A —1 <br />� <br />�--� N <br />� <br />�'I <br />O A <br />�n <br />3 <br />-i m <br />2 <br />m «-� <br />N <br />O <br />or <br />c� m <br />C 1/� <br />mN <br />z c� <br />-r r <br />• m <br />a <br />� <br />�--I <br />S <br />� <br />Z <br />--1 <br />S <br />i--� <br />N <br />Z <br />O <br />--I <br />f'> <br />m <br />