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the Evergreen <br />CITY OF <br />e��erett <br />259-8745 <br />� C^)NSTRUCTION - <br />PERMIT <br />PERMIT NQ: , � � � `� � <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL '�J PLUMBING C� SIGN <br />p�yryEq MAILAODRE55 CITY 21P PNONE <br />John DeWispelaere 5824 Lowell Rd. E1�erett, WA 98203 355-2594 <br />APCHITECT OR DESIGNER MAIL ADDHE55 CITY 21P PMONE <br />GENERALWNTBFCTOR MAILAOORESS CITY ZIP PNONE LICENSEr <br />MEGMNNICAL CONTRACTOR MAiL ADDRE55 CITY ZIP PNONE LICENSE • <br />PWMBINGCOHTFACTOR MAILAODRE55 CITV ZIP PHONE �ICENSE� <br />Owner <br />CLA55 OF WORK � <br />❑ NEW ❑ ADDITION FS7 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALURTION OF WOliK <br />$ <br />Put nc��v fixtures in , replace. <br />HEATSOURCE <br />O ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />residence <br />ior _ ewcK _ <br />5824 Lowell Rd. <br />PLUMBING <br />NO. I TYPE OF FIXTUHE O <br />1 iNATER CLOSET (TOILET) <br />]. BATHTUB <br />]. LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />DISHWASHER <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />B�CKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL S <br />PEHMIT S <br />TOTAL FEE S <br />1NE LOTAaEa <br />IFGONS` OCCUPANCYGROUP <br />F9LOG. NO.OFSTORIES <br />iPRINKLERS REOUIRED ❑ VES ❑ NO <br />JATION ACC. �Y PLANS CHECKEO DY <br />S.H. <br />FEE <br />VACAI'T SITE <br />❑VES ❑NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION 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 SPECIFIL"D HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF RNY OTHER <br />STATE OR LOCAL LAW REGULATING CQNSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCT�ON. <br />SIGNAZUREOFGONTlHCTOfLAUTWORIZE�pGENT.OROWNER OA1F. <br />NO. TYPE OF EOUIPMENT <br />OO A/C—A/HNOLGUNITS—H.P. <br />OO REFRIGERATIONUNITS—H.P.EA. <br />OO BOILERS—B.T.U./H.P. <br />GAS FIREO A.C. UNITS — B.T.U. <br />FOHCED AIR SYSTEMS — B.T.U. M EA. <br />WALLHEATERS—BS.LL M <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVECOOLEFS <br />CLOTHF_5 DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER � <br />WOOUSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSEPT <br />HEAT PUMP <br />GAS PIPING <br />E%HFUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />�LAN CHECK NUMBEH FEE <br />FEES VALU <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />INVESTIGA710N FEE <br />S7ATE BUILDING SURCHARG <br />STATEENERGYSURCHARGE <br />DRIVEWAY PERMIT <br />Sec.3041e) <br />rcc <br />RECEIPT NO. <br />TOTAL I I <br />PEflM1T VALIDATION <br />WHEN PROPERLV VALIDATEO (IN THIS SPACE) THIS IS YOUR FEFMIT <br />