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the ElUergreen <br />CITY OF <br />everett <br />259-8745 <br />rONSTRUCTION - <br />PERMIT <br />PERMIT NQ: _- l 7379 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING RMECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDFESS CITY ZIP PHONE <br />DOUG ROLLINS 2129 Madison Everett WA 98203 347-1992 <br />ARCHITECT OH DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />Valley Natural Gas 11323 Highway 99 Everett WA 98204 355-7730 <br />PLUMBING CONTRACTOR MAIL ADCRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />O NEW O ADDITION E] ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />s <br />DESCRICE WORK <br />Install 100M btu furnace and water heater <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE '3 OTHER <br />PROPOSED USE OF BUILDING <br />Residence <br />1 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 SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU OF CONT9APTOR. AUTHORIZED AGENT. OR OWNER DATE <br />10/28/86 <br />LEGAL DESCR-PTION OF PROPERTY ISHOW EELOW OR ATTACH FOUR COPIESI <br />LOT __ BLOCK _ OF— <br />JOB ADDRESS <br />2129 Madison <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./HP. <br />SHOWER <br />GAS FIRED A . UNITS — B T.U. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS — B.T. M EA. <br />DISHWASHER <br />WALL HEATERS —B.T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.J. M <br />CLOTHES WASHER <br />tq <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN 10/28/86 4:47Fi <br />GOW02704 <br />**3 <br />FLOOR DRAIN <br />RANGE HOOD <br />RACKFLOW PRFVENTERS <br />1 <br />WATER HEATER - NOW17379 <br />ROOF DRAINS — RAINLEADERS <br />:' <br />WOOD STOVE MECH tQ.' <br />SINK (SERVICE — BAR, ETC.) <br />`P,'I <br />METAL FIREPLACE & CHIMN CHEEK p'l <br />50 <br />FIREPLACE INSERT <br />HEAT PUMP <br />1 <br />GAS PIPING <br />I <br />E%HAUSTFAN <br />SUBTOTAL <br />$ <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT 1 <br />15 <br />00 <br />TOTALFEE <br />$ <br />TOTALFEE 5 <br />3 <br />1 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />FLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />OVACANT yEs SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLOC <br />NO OF STORIES <br />MAX CCC LOAD <br />MECHANICAL <br />33 <br />50 <br />FIRE SPRINKLERS REOUIRED DYES ONO <br />INVESTIGATION FEE <br />Sec. 304(e) <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />- <br />TOTAL <br />33 <br />50 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />Cn <br />E. - <br />AGOFESS FILE <br />