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fhe Evergreen <br />CITY OF <br />everet� <br />259-8745 <br />C„`1NSTRUCTION <br />PERMIT <br />i'-• <br />PERMIT NO. 2O� �'f <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �7 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MHIL ADORE55 CITY <br />21P PHONE <br />Allan Schirman P.O. Box 1514 Shelton, WA 98548 926-�6 7349 <br />ARCMITECTORDESIGNER MAILADDRE55 CITV pip PHONE <br />GENERAL CONTqAGTOR MAIL AOOPESS ^ITY Zip PHONE LICENSE � <br />owner <br />MECHANICALCONTRACTOR MAILADORE55 QTY ZIP PMONE LICENSE� <br />PI.UMBING CONTPACTOR MAIL ADDFESS CITY ZIP PHONE LICENSE � <br />:LASS OF WOflN <br />❑ NEW ❑ ADDITION <br />S <br />❑ ALTERATION ❑ REPAIR ❑ DEMOLITION O BUILDING RELOCATION <br />Fireplace insert <br />MEATSOUPCE <br />❑ ELECTRICITV ❑ GAS ❑ WOODSTOYE ❑ OTHER <br />home / rental <br />LOT _ 6LOL:< <br />921 Lombard Ave <br />PLUMBING <br />TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUO <br />LAVATORV�NASHBASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS — RAINLEADERS <br />SINK (SERVICE —BAF. ETC.) <br />USEZONE <br />TYPE OF CONST. <br />s¢eoFo�oc. <br />FIRE SPRINKLERS R <br />�PPLICATION ACC. BY <br />M.M. <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />OCCUPANCYGpOUP <br />S <br />5 <br />COPIES� <br />SITE <br />❑ NO <br />MAX. OCG �OAU <br />PLANS CMECNEO BY I/PP� FOR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI� <br />APPLICATION ANJ KPJOW THE SAME TO BE: TRUE ANU <br />CORRECT. ALL PROVISIONS OF LAWS AND C`RDINANCES <br />GOVERNING THI� �YPE OF WORK WILL BE COMPLIED WITH <br />WHETHER S!'ECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOE� NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY 07HER <br />STATE OR �OCAL lA1N REGULAI'ING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGN4Tl1RE OF CONiPACTOR. AUTHORIZED AGENT. OR OWNER OATE <br />X ���� � ��/�� x9x(s 5-16-88 <br />MECHANICAL' <br />TYPE OF EQUIPMENT <br />A/C — A/HNOLG UNITS — H.P. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — B.T.U.MP. <br />GAS FIRED A�G UNITS — B.T.U. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALLHEATEflS—B.T.U. M <br />UNITHEATER3—B.T.U. M <br />EVAPOFATIVE COOLERS <br />CLOTHESORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIRcPLACE 8 CHIMNE�� <br />FIflEPLACE WSEflT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />PLAN CHECK NUMBER <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAI <br />INVESTIGATION FEE <br />SUBTOTAL <br />PEflMIT <br />TOTAL FEE <br />FT- <br />3 <br />RECEIPT NO. <br />FEE <br />I 30 I00 <br />O5/fldc/89i�1=� AH OOOAH0604 :k:k:KK <br />S7ATE BUILOING SURCHARGE � � <br />STATE ENEFGV SURCHAFGE j�jE�{ $3 .00 <br />DRIVEWAV PERMIT � <br />TOTAL <br />PEHMIT VALIDATION <br />WNEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS VOUR PERMIT <br />� ; .,:_:, <br />