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u� � <br />CITY OF <br />everett <br />259-3745 <br />( C�NSTRUCTION r ' <br />PERMIT PERMIT NQ: _ 20319 <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING �{MECHANICAL 'O PLUMBING ❑ SIGN <br />OMTlEH MAIL I.DDRESS �ITY 21P MONE <br />Carroll Tiede 5024 Dogwood Drive �erett 98203 259-1005 <br />ARCHITECTORDESIGNER MRILr�DNf'.� CITY ZIP PHONE <br />GENERAL CONTRRCTOP MRR AODHE55 dTY ZIP PMONE LICENSE � <br />MECH�NIUL CONTRAGTOfI MAIL ADOPESS ��TY b' PHONE LICENSE • <br />Valley Natural Gas 11323 Highway 99 Everett 98204 355-7730 <br />PLUMBINGCONTRACTOR M�ILADDRE55 diV ZIP PHONE 4CENSE� <br />VALLENG 153 LI <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIH ❑ DEMOLITION <br />VALUATIOI:OF WORK <br />{ <br />DESCHIBE WORK <br />Install Water Heater <br />❑ ELECTRICITY O GAS ❑ WOODSTOVE ❑ OTHEH <br />SFR <br />ior _ e�oc� _ or <br />5024 Dogwood Drive <br />P:.UMBING <br />TYPE OF FIXTURE OR ITEM <br />WATEF CIOSET (TOILET� <br />BATHTUB <br />LAVATORY(WASHBASIN� <br />KITCMEN SINN 8 Gi iP, <br />D�SHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINRL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS — PAINLEADERS <br />SINK (SEPVICE — BAR, ETC.) <br />BUBTOTAL <br />PERMII' <br />T0711L FEE <br />USE20NE <br />OLCUPANGYGROUP <br />512E OF BLDG <br />�I'PLICATIONACC OY <br />WCpNT SITE <br />❑YES ❑NO <br />OCC LOnD <br />APPR FON I:SURNCE �V <br />❑ BUILDING REIOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AVD EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVEPNING 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 <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHEF <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNFtURE Oi 0�p9, ApTMOR12E0 r1GENT. OR ONrtJER � 1 pATE v� <br />X ' 9` 20- � <br />MECHANICAL <br />TYPE OF EOUIPMENT <br />A/C — A/HNDLG UNITS — H.P. <br />REFRIGERATION UNITS — H.P. EN. <br />BOILERS — B.T.U./H.P. <br />GAS FIREO A.C. UNITS — B.T.U. <br />FOHCEDAIRSVSTEMS—B.7.U. M <br />WALL HEATERS — B T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVECOOlERS <br />CLOTHESORVERS <br />VENTILATION FAN (����� <br />RANGEHO00 � <br />WATER HEATER • �';; <br />WOODSTOVE �'(� <br />METAL FIREPLACE 8 CMIMN�'j�(�( <br />FIREPLACEINSERT <br />MEAT PUMP <br />GAS FIPING <br />EXHAUS7FAN <br />SUBTOTAL <br />PEflMIT <br />TOTALFEE <br />BUILDING $ <br />PLUMBING <br />MECHANICAL <br />IMVESTIGATION FEE Sec.304�e) <br />STATE dUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />ONIVEWAY PEHMIi <br />TOTAL 21 <br />PERMIi VALIDATION <br />WMEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS VOUR PERMIT <br />ADDRESS FILE <br />50 <br />