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u��.,�.� <br />GTY OF <br />ever�ett <br />259-8745 <br />�NSTRUCTION <br />PERMIT <br />FcRMIT NO. 17140 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING Cl MECHANICAL ❑ PLUMBING D SIGN <br />O»'�a M�IL�DDRE55 CITY ZIP PMONE <br />GEORGE HINTON 5116 Dogwood Everett WA 96203 <br />MCHITECTORpE510NER MAIL�DDi1F.55 CITV ZIP PHONE <br />OENEMIGONTRACiOR MAILADORESS CITY ZIP PHONE UCENSE� <br />Same <br />MECMIINIG . CONTR�CTOH M�IL �DDRESS CITY 21P PHONE IICENSE 1 <br />AUMBINOCONTPACTOR M�IL�ODNE55 CITV ZIP PHONE LICENSE� <br />CL�55OF WORN <br />❑ NEW ❑ ADDITION <br />VALUATION OF WORK <br />{ <br />OESCRIBE WORK <br />Wood stove <br />O ELECTRICITY <br />'ROPOSED USh OF BU�winu <br />Residence <br />1 OT � BLO�:K _ Of <br />PLUMBING <br />USE <br />❑ ALTERATION ❑ REPAIR <br />❑ GAS ❑ WOODSTOVE <br />5116 Dogwood <br />WHTER CLOSET (T011l <br />BATHTUB <br />LAVATORY�WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />OISNWASI IER <br />IAUNDRVTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — AA��'LEADERS <br />SINK (SERVICE — BAR, ETQ) <br />SUBTOTAL <br />VERMIT <br />TOTAL FEE <br />LOT RRER <br />GUPIE51 <br />S <br />S <br />f <br />FEE <br />�ACIINT SITE <br />❑YES ❑NO <br />NO Of pWELLING UNITS <br />APPLICRTIDN ACC. BY � PLANS CHECKEO OY I APPR. FOR I$$UANCE OY <br />❑ DEMOLITION <br />❑ OTHER <br />❑ BU�LDING RELOCATON <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 HEREIN OR NOT. THE GRANTING OF A <br />PEfiM1T DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PEfjFORMANCE OF CONSTRUCTION. <br />SIGNATUfiE.OF CONTRACTOR. AUTNORIZED AGENT.OR OWNER DATE <br />MECHANICAL <br />FEE <br />A/C — A/HNDLG UNITS — HP. <br />REFRIGERATION UNITS --H.P. EA. <br />BOILEFS — BS.U.MP. <br />fiAS FIRED A�C. UNITS — B.T.U. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALLHEATERS—B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />tVAPORATIVECOOLERS <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER�HEATER ' <br />YJOOD STOVE <br />METAL FIREPLACE 8 CHIMN <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />9UB TOTAL 3 <br />PERMIT <br />TOTALFEE <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />FEES VALUATION FEE <br />BUILDING $ <br />PLUMBING <br />MECHANICAL <br />INVESTIGATION FEE Sec. 304(c) <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHAfiGE <br />DRIVEWAY PERMIT <br />TOTAL 3O OO <br />PERMIT VALID�TION <br />WHEN PROPERLV VALIDATED pN THIS SPACE) THIS IS VOUR PERIAIT <br />� <br />C�' <br />r� <br />L` <br />r� <br />f.I;:N[`.'� �Il.l_ <br />