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� <br /> nc�£ver,�reen � - /ONSTRUCTIOf� <br /> (;ITY OF � <br /> everett PERMlT PERMIT N0. 1463$ <br /> CITY HALL 259�8745 <br /> EVERETT,WA98201 � COMBINATION ❑ BUILDING :�xl MECHANICAL ❑ PL�JMBING <br /> 01YNER MAIL ADDRESS CITY ZIP PMONE <br /> AL CAMBER 4927 Elm Street Rvere*t Wa 9820a z4a-77�a <br /> rARGHITECT OR OESIGNER MAIL PDDRESS GITY ZIP �MONE <br /> GENERnL GONTRACTOR MAIL ADDRE55 CITY 21P PHONE LICENSE p <br /> Same <br /> MECHANICAL GONTFRCTOP MAIL AODRE55 CIiY ZIP PHONE LICENSE� <br /> PLUMBING ANTRAGTOR MAIL ADDRES$ CITY ZIP PHONE LICENSE Y � <br /> � <br /> � <br /> CUSS JF WORK <br /> O t:cW ❑ ADDITION ❑ ALTERATION ❑REPAIP ❑ DEMOLITION ❑ FENCE ❑ SIGN � WOOD STOVFJFIREPLACE INSEfiT <br /> VALUATION OF WORK <br /> f <br /> OESCR19E WOHN <br /> Install wood stove <br /> PROPOSEO USE OF BUILOING <br /> Residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAL DESCRIPTION OF PROVERTY(SNOW BELOW ON ATTACM FOUR COPIES) GORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> L0T__BLOCK_OF GOVERNING THIS TYPE OF WORK WILI. BE COMPLIED WITH <br /> WHETHER SPECIFIED HEREIN 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 /> PERFORMANCE OF CONSTRUCTION. <br /> JOB ADDRE55 SIGNATUR OF O ACTOR OR A HORIZED AGENT OATE <br /> 4927 Elm X <br /> 1'LUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET�TOILET) AIR COKD.UNI75— H.P. EA. <br /> BATHTUB REFRIGERA710N UNI fS— H.P.EA. <br /> LAVATORY�WASH 5:�;.iN) BOILERS—H.P. EA. <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK 8�ISP. FOFiCED AIR SVSTEMS— B.T.U. M EA. <br /> DISHWASHER WALL FiEATERS — B.T.U. h1 <br /> LAUNORV TRAY UNI7 NEATERS— B.T.U. A1 <br /> CLOTHES WASHER EVf.PORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN _ <br /> C+RINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— G.F,M. <br /> VACUUM BREAKEFS 1 STOVE— WOOD <br /> ROOF ORAINS — RAINLEAOERS METAL FIREPLACE 8 CHIMNEY <br /> SINK(SERVICE— BAR, ETC.) FIREPLACE INSE77 <br /> HEAT PUMP <br /> SUB TOTAL ± SUB TOTAL S <br /> PERM�T S PEH�'IT S <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> SIDE YARD SETBACK STREET SEi04CK REAH YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITL <br /> ; ;YES I�.NO FEES VALUATION FEE <br /> TY?E OF CONST. OCCUPANCY GROUP tJO.OF�WELLING UNITS <br /> BUILDING S <br /> SIZE OF BLDG. NO.OF STORIES t.tAX.OCC. LOAD " <br /> PLUMBING <br /> FIRE ZONE BAS�AtENT FIRE SPRINKLERS MECHANICAL <br /> REOUIRED � <br /> YES ' NO <br /> APPHOVALS BY DATE �THER <br /> 1.ENVIRONAIENTAL CHECK LIST PENALTY U.B.f.. <br /> SEC.303(al <br /> 2.BUILDING PLANS <br /> 3.FIRE HYDRANT TOTAL <br /> 4.FIRE PFOTECTION SYSTEM PENMIT VALIDATION <br /> 5.GHADING WHEN PROPERLY VALIDATED pN 7HI5 SPACE�THIS IS YOUR.PERMIT Q� <br /> L 6.DRAINAGE I 1 ' _ m! <br /> 7.ENVIRONMENTALIMPACTSTATEMENT � <br /> 8.HEA.TH DISTfiIi.T � ; � � <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY � � <br /> i <br /> i <br /> ADDRESS FILF , <br /> � <br />