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lhr L�cCrl'rrivt �� �V C � l�� ■ �� � � -. <br /> everett PERMIT PERMIT NO. 14g 2 <br /> CITY HALL 259�8745 <br /> 12VERETT,WA98201 � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OYlNE3 MAILADOPESS GIiV ZIP PHONE <br /> C.E. Tollefson 1119 Lombard Everett 98201 252-184R <br /> APGHITEGT OR OESIGNER MAIL ADDPESS G'TY 21P PNONE <br /> GENERFL CONTRACTOR MAIL AOORESS CITY ZIP PMONE LICENSE I <br /> MECHANICAL CONTRACTOR MAIL ADORESS CITY ZIP YMONE LICENSE 1 <br /> Same <br /> PWNBING CONiRACTOR MAIL PODRESS CI1Y ZIP PMON`_ LICENSE tl <br /> CLASS OF WORN <br /> ❑ NEW O AODITION ❑ ALTEPATION O REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSEFIT <br /> VAWAiION OF WORN <br /> f <br /> DESCRIOE WORK <br /> Install wood rstove <br /> PROPOSED USE OF BUILOING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAL DESCRIPTION OF PFOPERTV�SHOW BELOW OR AiTACN FOUN COPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINAIVCES <br /> LOT_BLOCK_OF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRA�ITING OF A <br /> PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTI N. <br /> J08 NDDHE55 SIGN OF W CT 0 ENT DATE <br /> 1119 Lombard 6/12/85 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. IYPE OF EOUIPMENT fEE <br /> WATERCLOSET�701LEn .4IR COND. UNITS — H.P. EA. <br /> BA7HTUB REFRIGERA710N UNITS— H.P. EA. <br /> LAVATORVIWASH BASINI BOILERS— hi.P. EA. <br /> SHOWER GAS FIRE�A.C. UNITS—TONNAGE EF. <br /> KITGHEN SINK 8 DISP. FOFCED AIR SYSTEMS— B.T.U. M EA. _ <br /> DISHWASHER WAI.L HEAT[R's— B.T.U. M <br /> LAUNDRVTRAY UNIT HEAT[RS— B.T.U. M <br /> CLOTHES WAEHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> fiRINKING FOUNTAIN RANGE HOGD <br /> FLOOR DRAIN AIR HANDLING UNI7— C.F.M. <br /> VACUUM BREAKERS STOVE — WOOD <br /> ROOF�RAINS — RAINLEADERS ]. METAL FIREPLACE 8 CHIMNEY �I SO <br /> SINK(SERVICE — BAR, ETC.) FIREPLACEINSERT <br /> HEAT PUMP <br /> SUB TOTAL '> SUB 70TAL 5 7 SO <br /> PERMIT S PEPMIT 5 <br /> TOTAL FEE E 70TAL FEE 5 7 SO <br /> SIDF YARD SE7DACK S7REETSETBACK REAR YARD SETBAGK PLAN CHECK NUMBBR PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> �.:YES ..NO FEES VALUA710N FEE <br /> TYPE OF CONST. OCCUPANCY fiROUP NO. OF DWELLING UNITS <br /> BUILDING S <br /> SIZE OF BL�G. NO.OF STORIES MAX. OCC. LOAD <br /> PLUMBING <br /> FIflE ZONE BASEMENT FIRE SPRINKLERS MECHANICAL � SO <br /> RE�UIRED <br /> � �.YES "_NO <br /> APPROVALS BY DATE OTHER <br /> 1. ENVIflONMENTAL CHECK LIST pEMALTY U.B.G. <br /> SEC.303(a1 <br /> 2.BUILDINGPLANS TOTAL � SO <br /> 3.FIRE HYDRANT <br /> 4.FIRE PROTECTION SYSTFM PERMIT VALIDA710N <br /> 5.GRADIIJG WHEN PROPEPLY VALIDA7ED(W THIS SPACE)THIS IS YOU( P.ERMIT �J <br /> 6.ORAINAGE Add t0 permit #.14531 ~ <br /> � <br /> 7.ENVIRONMENTALIMPACTSTATEMENT � <br /> B.HEALTH DISTRICT ' � <—� <br /> APPLICATION ACC. BY PLANS CHECKED BV APPR.POR ISSUANGE BY � ' <br /> nUD2e5� i-1f[ . <br />