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�� <br />GiY JF <br />everett <br />259-8745 <br />❑ DEMOLITION <br />- �"ONSTRUCTION <br />PERMIT PERMIT NO. 1866,� <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL � P�UMBING ❑ SIGN <br />PHONF <br />515 S. FLower St <br />IaiS <br />C�TY 21P <br />C1� 98061 <br />'-- MAIIADCAESS CITY "• � - <br />ARCNITECT OR DESIGNER <br />GENERALCONTRRGTOR MAILAOORESS <br />CITY ZIP PMONE LILENSE M <br />_ f11V Z�p PHONE LICENSE• <br />MUMBING GONTRACTOR <br />MAILPDDHE55 GTY •'� -----�- <br />A-1 Pepperworth P.O. Box 5994 Bellingham 98227 743-2212 ALPEPP 2 JL <br />CUSS OF WORN <br />[� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATIO <br />VALUATION OF WORK <br />S 5Z0�.0� <br />DESCRIBE WORK <br />Rough-in Pluming <br />HERT SOURCE ❑ OTNER <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE <br />Retail <br />LOT �� OLOCK � <br />zzo <br />PLUMBING <br />p, TYPE OF PI%TURE OR <br />� WATER CLOSET (TOILET� <br />BATHTUB <br />� LAVATORY (WASH OASIN) <br />SHOWEFi <br />KITCHEN SINK 8 DISP. <br />OISHWASHER <br />1 LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />$ FLOORORAIN <br />OACKFLO�VPREVENTERS <br />2 ROOFDRAINS—AAIMLEAOERS <br />SINK �SERVICE — BAR. ETG) <br />� <br />� <br />TYPE <br />S.H. <br />SUB TOTAL <br />PERMIT <br />TOTRLFEE <br />pY � PLANSCMECHED <br />FEE <br />5 <br />S� E <br />ilpE SETAACK <br />VACANT SITE <br />❑YLS ❑NO <br />NO OF D\VELLIN( <br />MA% OCC LOAD <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />CORRECTIOALL PROV SOIONS OF LAWS AND ORD NANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR IJOT. THE GRANTING OF A <br />VIO A'TE OR SCA CEL THE PROV�ISIONS OF TANYRIOTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAI E OF CONTRAGTON Hq� ZED �GENT, OR OWN[R OATE <br />X�i+�� �� ! �r�L/� C� 4 -��' -:�r7 <br />TYPE OF EOUIPMENT <br />q�C — A�MNDLG UNITS — HP. <br />REFRIGERATION UNITS — H P. EA. <br />BOILERS — B.T.0 /H P. <br />G 4S FIRED AA. UNITS — B TL. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />Wq�� HEATERS — B T.0 M <br />UNIT HEATERS — B.T U. M <br />EVAPORATIVE C �OLERS <br />CL(,T' iLS t`AVERS <br />VENiILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE _ <br />METAL FIREPLACE 8 CHIMNEY <br />FIPEPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />pCRMIT <br />TOTAL FEE <br />PLAN <br />BUILDING s <br />, „`i,:�,., :- '� ll(:;:^.n <br />PLUMBING _"._ ,�.: �. :i�/l ��L•r•��i� <br />MECHANICAL ,�(_!'��_t;�zb�l <br />INVESTIGATIONFEE '-�����) t` r�l <br />STATE BUILDING SURCHARCoE � � � ;:�1 <br />STATEENERGVSURCHARGE <br />DRIVEWAY PERMIT <br />TOTAL <br />� PERMIT VALIDATION <br />\YHEN PROPERIY VALIDATED �IN THIS SPACE) ThIIS IS YOUR PEHhIIT <br />�� <br />� <br />86150 <br />• <br />