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� <br /> Nie E��er�;reen O N ST R U CT I O � � <br /> evere�t �� --_+� <br /> PERNIIT PERMIT Nfl. 15 j� 3 <br /> CITY HALL 759�8745 <br /> EVERETT.WA98201 � COMBINATION ❑ BUILDING X�'k MECHANICAL ❑ PLUMBING <br /> OWdER MAIL AD�RE55 GITY ZIP PMONE <br /> Jeff Puthoff 29Q2 05th Street S.E. Everett 98204 337-6264 <br /> AflCHITECT OR DESIGNEfl MAIL ADDRE55 CITY ZIP PMONE <br /> GENERAL WNiRACTOR MAIL AODRE55 LITY 21P PHONE LICEIISE X <br /> MECHAIUCAI CONTRACTOfl MAIL AOORESS CITV 21P PHONE LICENSE M <br /> Same <br /> PLUNBING GONTRACTOR MAIL A�DRESS GTY ZIP F 10NE LICENSE p <br /> ;LASS OF WORK <br /> ❑ NEW ❑ A�DITIOtJ ❑ AL7ERAliCN ❑REPAIR ❑ DEMOLITION O FENCE O SIGN �K WOOD STOVE/FIREPLhCE INSER7 <br /> YFLUATION OF WORK <br /> S <br /> DESCflIBE WORK <br /> Install fireplace insert <br /> PROPOSE�USE OF BUILOiNG <br /> Single Family Residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO 8E TRUE AND <br /> LEGAl0E5CFIPT�CN OF PROPEFTY(SHOW�ELOW OR ATiACM FOUR COPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> 1 566 Everett GOVERNING THIS TYPE OF WORK WILL BE COMPIIED WITH <br /> �c-_o�ocK_oF WHETHER SP[CIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERMIT DOES NOT PRESUME TO GIVE AUTHORITYTO V�OLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONS TION. <br /> JOB AD�RESS S�GNATU = CG ACTOR OR MORI AGENT OATE <br /> 2501 L�mbard X 11/19/85 _ <br /> PLUMBING MEC NICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET�TCILET.) AIR COND.UNITS — H,P. EA. <br /> BATHTUB REFRIGERATION UNITS— H.P. EA. <br /> LAVATORYIWASH BASIN� BOILERS — H.P. EA. <br /> SHOWER GAS FIRED A.C.UNITS— T�NNAGE EA. <br /> I(ITCHE�SINK 8 DISP. FORCE�AIR SVSTEMS — B.T.U. M EA. <br /> DISIiWASHER WALL HEATERS— B.T.U. ry1 <br /> LAl1N�RY 7RAY UNI7 HEA7ERS— B.T.U. M <br /> CLOTHES WASHEFi EVAPORA7IVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> UFINAL VENTILATION FAN <br /> ORII�KING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN 41R HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE —WOOD <br /> ROOF ORAINS— PAINLEADERS METAL FIREPLACE 8 CHIMNEY <br /> SINK(SERVICE— BAR, ETC.) 1 FIREPLACE INSERT <br /> -- — HEAT PUMP <br /> SUB TOTAL S SUB Tt77AL 5 � SO <br /> PERMIT S PEHMIT S 10 �0 <br /> 70TAL FEE S TOTAL FEE S 17 SO <br /> SIDE YAR�SETBAGK STREETSETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE FECEIPI NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUA710H FEE <br /> �. �.YES ;�;NO <br /> TYPE OF CONST. OCCUPANG�GROUP NO.OF DWELLING UNITS <br /> BUILDING S <br /> SI2E OF BLDG. NO.OF STORIES MAX.OCC. LOAD <br /> PLUMBING <br /> FIRE ZONE BAS'cMENT FIRE SPRINKLERS p�ECHANICAL 17 SO <br /> REDUIRED <br /> !:YES f7N0 <br /> APPROVALS BY DATE O7HER <br /> U.B.C. <br /> 1. ENVIRONMEN7AL CHECK LIST PENALTY SEC.303(a) <br /> 2.BUILDINGPLANS TOTAL 1� SO <br /> 3.FIRE HYORFNT <br /> 4.FIRE PROTECTION SYSTEM PEFMIT VALIDATION <br /> 5.GflADING WHEN PROPERLY VALIDATED(IN THIS�S�ACE)THI�I V �E IT (�'f <br /> 7 0 ., � P`� � �"- �� <br /> 6.DRAINAGE r' <br /> 7.ENVIRONMENTALIMPACTSTATEMEN7 U1 <br /> B.HEALTH OISTRIGT � '.� �=� P. I �,.�C. L I PT ��� <br /> APPLICATION ACC. BY PLANS CHECKED BY APPR. FOR ISSUANCE BY <br /> � �, .. � ( <br /> , . . .. . . i .. _ <br /> � j i,J� u7 <br /> AGDRESS PILE <br />