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the E�ergreen <br /> everett �'d�STRUCTIOiV - <br /> 259 -8745 <br /> P�RMIT PERMITIVQ:_ � �`�U� <br /> ❑ DEMOLI710N ❑ COMBINATION ❑ BUILDING �] MECHANICAL i] PLUMBING ❑ SIGN <br /> OWNEN MAiLA00RE55 CITY ZC pHONE <br /> Keirl A. Hoffman 22090 I,ombard Ave Everett, WA 9II201 334-2613 <br /> ARCHiIECTOR�E5IGN[R MAILADDRE55 CITY ZIP PHONE <br /> GENERAICONTFACTOR MAILGOORE55 GTV ZIP PM1ONE �ICENSEr <br /> MECHANICAI LONTPACfOP MAIL qDDRESS CITY ZiP oqpNE LILENSE M <br /> Valley NaYu_al Gas 11323 Hc•ry 99 Everett, �9A 98204 355-7730 VALLENG153LI <br /> PLUMBINGCONT{iACTOP M�1ILADORESS CITY ZIP PHGVF LICENSE+ <br /> CLASS OF WORK -�' <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br /> VnLUNTION OF WORK <br /> s B63.73 <br /> DESCRIBE WOFK <br /> Install conversion burner/Install water heater <br /> tlBAT50UFCE <br /> ❑ ELECTRICITY I7 GAS ❑ WOODSTOYE ❑ OTHER <br /> PFOPOSED lISE OF pUIL�ING <br /> Residential Single Family I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SF�ME TO BE TRUE AND <br /> LEGRL�ESCRIPTIONOfPROPERTY�SMOW�ELOWORATTA('HfO11RCOPIES) CORRECT. ALL PROVISIONS OF LHWS AND ORDINANCES <br /> lOT_BLOCK _ OF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT. THE GRANTIN3 OF P. <br /> PCf1t.11T DOC.^� WOT PR[SUt�iE Tv GI've r�UTHuFITY TO <br /> � VIOLATE OR CANCEL THE PROVISIONS OF AIJY OTHER <br /> STATE OR IOCAL LAW REGULATING CONSTRUCTION OR <br /> THE PERFU�'MANCE OF CONSTRUCTION. <br /> J00 ADORESS SIGN4TlIRE OF CUNTR�. 6.AUiH ZED AGENT.OR OV/NEN OATE <br /> 2209� Lombard Ave uDl�, � � h �-� �ZZ�86 <br /> . <br /> PLUMBING NrE HANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPC OF EOUIPMENT FEE <br /> WATEH CLpSET(TOILET) AiC—AiHNDLG UNITS—H P. <br /> BATHTUB REFRIGERATION UNITS—HP.EA. <br /> LAVATORV�WASH BASIN� BOILERS—BS.0 M.P. <br /> SHOWER GAS FIREO A�C.UNITS—B.T.U. <br /> KITCHEN SINK 8 DISP. 1 FORCED AIR SVSTEMS— B T.U. M EA. OO <br /> � DISHWASHEfl NlALLHEATERS—BS.V M <br /> LAUNURY iRAY UNIT HEATEflS—B.T.U. M � <br /> � CLOTFf�S WASNER EVAPORATIVE COOLERS <br /> �� CLOTHESD7VEflS <br /> DRINKING FOUNTAIN VENTILA710N FAN ' <br /> FLOOR lIRAIN RANGE HOOD <br /> BACKFL�7W PREVENTERS 1 WATER HEATER � <br /> ROOFDRAINS—RAINI.EADLRS WOODSTOVE <br /> SINK(SERVICE—BAR,ETC� METAL FIREPLACE 8 CHIMN�Y <br /> FIREPLACEINSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> EXHAUST fP.'J <br /> SUB TOTAL 5 � SUB TOTAL ..O <br /> PEHMIT 5 � PERN.IT 5 �,1 OO <br /> TOTALFEE S TOTALFEE S 3O SO <br /> FqOrvi sei5qcrc aEna seiaqCK SIDE SET�ACK PLAN CHECK NUMBER FEE Rf:CEIPT NO <br /> USEZONE LOTAREA VACANTSITE <br /> ❑ves ❑r+o FEES VALUATION FEE <br /> TYPEOFCONST. OCCUf'At�CYGRpUP NO.OFDWELLWGUNITS BUILDING g <br /> PLUMBWG i2/�2/E6 11=4 RM 00C1p#3396 ���KF��t <br /> 512E OF pLOG. NO OF STORIES NA% OCC LOAp _ _ <br /> MECHANICAL yMp1756� 90 50 <br /> INVESTIGATION fEE M�i.3oa�e� �'3 .5� <br /> FIRE SPRINKLERS qEOUIRED ❑YES ❑IJO � <br /> STATE BUILJING SURCHARGE <br /> STATE ENEriGY SURCHAFGE <br /> APPLICATIONACCQY PLPNSCHECKEO�Y APppFOf1155UANCEOV <br /> DRIVEWAV PERMIT <br /> M.M. TOTAL 30 50 <br /> PEHMIT VALIDATION ^^ <br /> WHEN PROPERLV VALIDATED pN THIS SPACE)THIS IS YOUR PERNIT <br /> .r� <br /> � <br /> � <br /> N <br /> � <br /> r,u�,�,��s „_� <br /> i <br /> f <br />