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"3eE°� � �' C�NSTRUCTION � � c <br />everett PERMIT PERMIT NQ; _ �Ou�� <br />259-8745 <br />❑ UEMOLI710N ❑ COMBINATION ❑ BUILDING � MECHANICAL O PLUMBING ❑ SIGN <br />OWNE(i MAIIFODRESS L Y ZIP PHONE <br />Patricia Nright 5528 LowellK Rd Everett 98203 355-5738 <br />ARCHITECTORDESiGNER MAILAODRE55 CITT ZIP PHONE <br />GENERALCONTRNGioN <br />MECMPNICALCONTRALTOR <br />owner <br />PLUMBING GONTRACTOR <br />LLASS OF WORK <br />❑ NEW ❑ AODITION <br />VALUATION Oi WOFN <br />S <br />MAIL AODRE55 <br />I IRIL ADDRE55 <br />MAIL AODf1E55 <br />❑ ALTERATION <br />CITY <br />GITY <br />CITY <br />❑ REPAIR ❑ DEMOLITION <br />Install fireplace inserr. <br />ME4f SOUliCE <br />❑ ELECiRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />8XX Si.ngle family dwe].li <br />EGAI O[SCRiPTION OF FPOPERTY �SNOW BELOW OR Al <br />LO"f �_ BLOCK _ OF <br />Ofi TOORESS <br />5528 Lowell Rd. <br />PLUMBINI. <br />Np, TYPE OF FIXTURE OR ITEM <br />TYPE <br />F'V�� <br />FIRE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORVIWASHBASIN) <br />SHOWER <br />KITCHEN SI�K A DISP. <br />DISHWASHER <br />LAUNDRVTRAV <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKfLOW PREVENT <br />ROOF DP.AIN$ — RAIP <br />$:NK�SERVICE — BAF <br />SUBTOTAL f <br />PERMIT S <br />TOTAL FEE S <br />'SETDACN REARS[TBACN SI�ESEtBACN <br />JNE ��T AREA yACANT SITE <br />❑YES ❑NO <br />)F GONST. OCCUPANGY GROUP NO. OF OWELLING UNITS <br />iF BLUG. NO. OF STOHIES MA%.00Q LOAD <br />SPRINKLERS REOUIFED ❑ VES ❑ NO <br />CATION ACC. �Y PLANS CHECNED BY APPF. FOB ISSUANCE DY <br />S.H. <br />21P •�ONE UCENSE � <br />ZIP PHONE LICENSEM <br />,+�p PMONE UCENSE M <br />❑ BUILbING RELOCATION <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />.4PPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />P[RMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL 7HE PROVISinNS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THFiPER ORMANCE OF CONSTRUCTION. <br />SIG ATURE CONTRACTOR.PUTHO�{IZEDAGENT.O�OWNEfl J/- OATE <br />X �.�, (�.' 2 <br />MECHANICAL <br />NO. TYPE OF EOUIPME <br />A/C — A/HIJDLG UNITS — H.P. <br />REFRIGERAI'ION UNITS — H.P. EA. <br />BOILERS — 8]71 /HP. <br />GAS FIRED A�C. UNiTS — B.T.U. <br />FORCED AIR SYSTEMS — b`! �. M�+� <br />WALLHEATERS—BT.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVE COOLFRS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERMEATER � <br />WOODSTOVE <br />METAL FIREPLACE 8 CHtMNEV <br />FIREPLACEINSEFT <br />HEATPUMP ���p�pp <br />GAS PIPING { <br />EXHAUSTfAN umn4nL04 <br />SUB <br />TOTALFEE <br />FEE <br />FEES � <br />Bl11LDING S <br />PLUMBING <br />MECHANICAL <br />INVESTIGATION FEE <br />STATE BUILDING SURCHARGE <br />STATEENERGVSUFCHARGE <br />DRIVEWAY PERMIT <br />TOTAL <br />Ser.. 304�a) <br />FEE <br />RECEIPT NO. <br />WHEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS VOUR PERMIT <br />'..0^IIESS Fii.E <br />M <br />� <br />C.� <br />O <br />N <br />