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i <br />r-, <br />theEvergreen ^ � 7NSTRUCTION � <br />CITY OF n <br />everett RER�IIT PERPNITNO. _ �`+834 <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDI�JG ❑ MECHANICAL �PLUMBING ❑ SIGN <br />OWNER MRILFO�PESS CITV ZIP PHONE <br />Paula Ney 320 - 69th St Everett 98204 353-6684 <br />TENNNT MFILAODRE55 CITY 21P PMONE <br />ARCHITEGt OR DESIGNER MAIL A�DRESS CITY ZIP PHONE <br />GENERPL LONTRAGTGR M41L ADORE55 CITY 21P PHO4E LICENSE • <br />owner <br />MECHANICALCONiRACTOR MRILAOOFE55 CITY ZIP PHONE LICENSE� <br />PLUM0INGCONTRACTOR MPILAD�PESS dTY ZIP PHONE LICENSEM <br />CLA55 OF WORN <br />fl NEW ❑ ADDITION ❑ ALTERATION �j{REPAIfl ❑ DEMOLIT�ON ❑ BUILDING RELOCATION <br />� I CONTACT PERSON AN� PNOrvt rvu ir � i nen � nrar ..ov.= <br />CONTRACT PRICE OF WORK S <br />DESCRIBE WORN ANO SOU/+RE FOOTAGE INVOLVED <br />New water pipe (copper) from street to house <br />PHOPOSED USE OF BULDING <br />Single family residence <br />LEGAL DESCFIPTION OF PROPEflTY (SHOW DELOV! OR A11ACH FOUR COPIES� <br />LpT - OLOLM. - OF <br />40 4'�9PM OOORx1999 kk:: <br />�oa noor�Ess <br />3516 Lombard <br />PLUMBING <br />NO. TYPE � <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK & DISP. <br />OR ITEM <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF URAINS — RAINLCADERS <br />SINK ISERVICE — BAR, ETC.) <br />USF <br />SiZE OF BLDG <br />OCCUPANCYtO/D <br />REASON FOF SPRINNLERS <br />APPLICATION l�CC.�V <br />SUBTOTAL <br />PEHMIT <br />TOTALFEE <br />REARSETBACK <br />LOT AR[� <br />IYPE OF CANSiFUuiION ACiOA� <br />NO OFSTORIES <br />RRE SPRINNIEPS REO'0 <br />O YES ❑ NO <br />DY <br />Fi <br />Ob/11/ •J <br />tt00024834 <br />�t."�— €' � LB <br />CHECf: �15.CD <br />MECHANICAL <br />FEE NO. TVPE OF EOUIPMENT <br />NC — A/HNDLG UNITS — H.P. <br />FORCED AIR SVSTEMS — B.T.U. M <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />� HEAT PU�dP — <br />GAS PIPING <br />E%HAl15T FAN <br />SUBTOTAL <br />PEHMIT <br />TOTALFEE <br />SIDESETBACK PLANCHECKVUIdBER FEE <br />VAC�NT SITE FEES <br />❑ VES ❑ NO <br />a�po�p� NOLF�V.EIutlGUNItS BUILDING <br />PLUMBING <br />OFSEMENT <br />❑ VES ❑ NO MECHANICAL <br />HEIGHTLIMITATION rJTHER <br />STATE 6UILDING SURCHARGE <br />STl�TE E�ERGY SURCHAFGE <br />CITY OF EVERETT pUBLIC WOPKS <br />LOCALSALES <br />TAX CODE IS rora� <br />3105 WHEN PROPERLY V/ <br />$ <br />THI <br />FEE <br />� <br />f <br />S <br />RECEIPT NO. <br />PER <br />PERMITS EHPIRE IF WORF: IS NOT COMMENCED WITHIN :;UURESS RLE ��i �I'1 -� <br />180 DAYS OR CEASES FOR MORE THAN 180 DAYS. <br />