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r <br />rhe £��r.,ereen <br />CITY pP <br />ev�rett <br />CITY HALL 259�8745 <br />;. <br />CONSTRUCTIO�" <br />PERIVIIT <br />P�RMIT PdO. 12H73 <br />EVERETT, WA 98201 � COMBINATION ❑ PUILDING � MECHANICAL ❑ PLUM�ING <br />1 <br />OWNEH MAILAppP555 CITY ZIP PNONE <br />Everett Fire Department 6801 Beverly Blvd. Everett 98204 <br />ARCMITECT OR pESIGNER MAIL ADOPE55 GITY ZIP PMONt <br />GENERAI CONTRACTOR MAIL ADDRESS CITY ZIP PMONE UCENSE M <br />MEGHANICRL CONTRACiOfl hIAIL ADDRESS CITY ZIP PMONE LICENSE Y <br />Natural Gas Equipment 1625 East Marine View Drive 98201 258-2441 <br />PLUMBING CONTRACTOR MAIL AD�RE55 GITY ZIP PHOHE UCENSE • <br />❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ DEMOLI(ION ❑ FENCE ❑ SIGN ❑ WOOD S70VE/FIREPLACE INSERT <br />s <br />LOT _ BLOCK __OF <br />PLUMBING <br />NO. <br />Beverly Blvd. <br />OR ITEM <br />WATERCLOSET�TOILEn <br />BATHTUB <br />LAVATORV ,NJASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDFYTNAV <br />CLOTHES WASHER <br />WATER HEA7ER <br />URIIJAL <br />ORINKING FOUNTAIY <br />FLOOR DPAIN <br />VACUUM BFEAKERS <br />HOOF DRAINS - RAINLEADcRS <br />SINK�SERVICE - BAP,E7C.) <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />OF <br />1. ENVIRONAIENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PflOTEGTIOPI SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />8. HEALTH <br />PIANS <br />S <br />5 <br />S <br />CYES CNO <br />MAX. <br />DATE <br />FOR ISSUANGE BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI" <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS A�D ORDINANCES <br />GOVERNING THIS TYPE OF WORY WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCEOFCONSTRUCTION. <br />SIGNATURE OF CONT ACTOR , AU7MORI' GENT � 1/GD%TBE4 <br />X `� ' <br />MECHANICAL <br />N0. TYPE OF E�UIPMENT FEE <br />AIF7 C!)ND. UNIrS - H.P. EA. <br />REF9IGERATInN UNITS - H.P. EA. <br />BOILERS - H.P. EA. <br />GAS FIREL` A.C. UNITS - TONNAGE EA. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />WAI.L HEATEFi - B.T.U. M <br />UNIT HEATEfiS - B.T.U. lOS M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />AIR HANULING UNIT — <br />STOVE — WOOD <br />METAL FlREPLACE & CHIMNEY <br />FIREPLACEINSEflT <br />HEAT PUMP <br />C.P.N. <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE f <br />;NUMBER P�AN ��� <br />FEE <br />FEES VALUATION <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTntR <br />PENALTY <br />5 <br />303 <br />i <br />RECEIPT NO. <br />FEE <br />17 150 <br />70S'AL I I 17 I50 <br />PEqMIT VALIDA710N <br />WHEN PROPERLY VALIDATED (IN THIS SPAyCGI THIS �SfT�fOPHP�T_� (Y� <br />bL I �DU 1 J w <br />� <br />Y�'�UP. RECEIPT� <br />-� �� ^,�;t Yo u <br />- 9 �r�� 8 4 <br />� <br />� <br />ADDRESS FILE <br />. � <br />