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the £�'erxreen <br />����r�� �� � C;ON�TRUCTIC�,i � <br />ev�rett PERMIT` PEr�MIT NO. 1�9E�9 <br />CITY HALL 259�8745 <br />EVERETT,WA98201 � COMBINATION ❑ BUILDING XI�J( MECHA�IiCAL ❑ PLUMBING <br />pWNER 1dA�.�_ ADORE55 C!TY ZIP PnONE <br />RICHARG WOLLAM 5724 LOWELL ROAD EV�RETT WA 98203 347-4527 <br />qpGMITEGT OR OESIGNEfl MAIL AODRESS CITV 21P PHONE <br />iENERAL GONTFACTOR MAIL ADDRE55 CITY 21P PHONE LICENSE M <br />Samt <br />MECHPNICAL CONTRACTOR MAIL AD9F%55 ':.ITY 21P PHONE LICENSE N <br />pLUMBING CONTRACTOfl MAIL ADDRESS CITY ZIP PMONE ULENSE / <br />❑ NEW ❑ ADDI710N ❑ AL7FFA710t1 ❑ REPAIR ❑ OEMOLITION ❑ FENGE ❑ SIGN C�] WOOD S70VFJFIREPLFCE INSERT <br />5 <br />ESCFI6E WORK <br />Install wood stove <br />ROPOSEO USE OF BUILDING <br />Single famil,v residence <br />EGAL DESGRIPTION OF PROPERTV (SMOW BELOV <br />�pT_BLOCK_OF <br />�oonooaess <br />5724 Lowell Road <br />PLUMBING <br />NO. TYPE OF FIXTURE OR I' <br />WATER CLOSET (TOIL[T) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHENSINK , DISP. <br />LAUnDRYTRAY <br />CLOT.iES WASHER <br />WATER HEATER <br />URINAL <br />[1RINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RHINLEADERS <br />SINK(SERVICE — BAR,ETC.) <br />SUB TUTAL S <br />PERMIT f <br />TOTAL FEE S <br />COPIES� <br />❑YES L;NO <br />TYPEOF WNST. OCCUPANCY GROUP NO.aFOWEL <br />S¢E OF BLDG. NO. OF STURIES MAX. OCC. lC <br />FIRE ZONE BASEMEN7 FIRE SPRINKI <br />FiE0U1RED <br />f�YES I_NO <br />A7PROVALS BY <br />1. ENVIRONMENTAL �HECK LIST <br />2. BUIL�ING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PRO7EC710N SYSTEM <br />5. GRAOING <br />6. DRAINAGF <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />B. HEALTH DISTRICT <br />nPPLICA7lON ACC. BY PLANS CHECKED BY APPR. FOR I: <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAPdE 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 />PERMIT DOES NOT PRESUMETO GIVE AUTHORITYTO VIOLATE <br />OR CANCEL THE PP,OVISIONS OF ANY OTfieR STATE OR <br />LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIA CE OF ONSTRUCTION. <br />SIGNATjU� OF NTRACTO R UTHO� 1,2E0/ AGf� 0 <br />X ///C'.� � �rUc✓�G07'h 1/22�6 <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UIJITS — TONNAG! <br />FOFlCED AIR SYSTEMS — B.T.U. <br />WALL HEA�ERS — B.T.U. <br />UNIT HEA7ERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — <br />� S70VE — WOOD <br />METAL FIREPLACE 8 CHIh1NEV <br />FIREPLACE INSERT <br />HEAT PUMP ' <br />CHEGK <br />HUILOING <br />PLUIdBING <br />fdECHANICAL <br />OTHER <br />PENALTY <br />SUB TOTAL <br />PEFlMIi <br />TOTAL FEE <br />FEE <br />F7 <br />EA. <br />M EA. <br />M <br />M <br />C.F.M. <br />S / <br />4 �� <br />S �� <br />�HE(:K FEE <br />RECEIPT NO. <br />VALUA710N I FEE <br />U.B.C. <br />SEC. 303 (a) <br />17 I50 <br />TOTAL I I �% I 5� <br />PERMI7 VALIDATION <br />WHEN PRO?ERLY VALIDATED (IN TH!5 SPACE) THIS IS YOUR PERMIT Qi <br />s,o�� �0 ! 7.50 --� <br />�1 <br />,. . .. . . '�^ �' I�ii� —. <br />. . . •'. .. ! f <br />FlDDRESS F!L[ <br />L � .,�,.i U J <br />