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rhP Eve� <br />cin oF <br />everett <br />259-8745 <br />$] UEMOLITION ❑ COMBINATtJN ❑ BUILDING ❑ MECHANICAL ❑ PWMBIN'3 _ ❑ SIGN <br />MAILAOORE55 CI�Y ZIP �HON[ <br />owr�ea � Mukilteo, :�A 98275 252-2052 <br />BGL Investments P:_L Box 767 <br />ABCMITECT OR U[S:GNER <br />MAILAOORE55 CITY 21P VHONE <br />- MAII AOORE55 CITY ZIP PHONE L'CENSE � <br />LENER.IL LONTR4CTOR <br />M[CMANICNLCONTRAGTOR MAILA�DRE55 CITV Zli PHONE UCENSE• <br />PWMPirvGLONTPAGTOF MML/ODRESS CITY 21P PMONE LICENSE• <br />C�7NSTRUCTICIN - . � �721 <br />PERMIT PERMIT NQ:- <br />c�nss oF wor+n <br />❑ NEW ❑ AUDITION ❑ ALTERATION ❑ REPAIR <br />VALUATION OF WORN <br />S <br />DESCRiBE WORN <br />Demolition of house (single family residence) _ <br />NEATSOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE <br />LGT __ OLOCK _ _ <br />F.ee attached <br />�oo nooaess <br />515 Madi <br />PLUM6ING <br />WAI� �. _OSET�TOILET� <br />BATH7UB <br />LAVATOPY�WASHBASIN) <br />SHOWEH <br />KITCHEN SINK 8 DISP. <br />LAUNDRVTFAI' <br />CLOTHES WASHF.R _ <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DFiAINS — RAINLEADE <br />SINK ISERVICE — BAR. ETC.� <br />TVPE OF CONS�. <br />OF 6LDG <br />M ACC �Y <br />CT <br />SUBTOTAL <br />PERMIT <br />TOTAIFEE <br />FEE <br />VAC�NT SITE <br />❑YES �NO <br />GROUP �NO.OF�WELL' <br />No. oP siuHies <br />) ❑ VES ❑ N <br />PLANSCHECK[D <br />�ono <br />APPP. iOR ISSUANCE OV <br />LC <br />❑ DEMOLITION <br />❑ OTHER <br />❑ BUILDING REIOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />GORRECT. ALL PROVISIONS OF LAWS AND ORDINANCE.�i <br />GOVERNING THIS �fYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUMF TO GIVE AUTHORITY TO <br />VIOLAIE OR CANCEL THE PROVIS�ONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PEF.FORMANCE OF CONSTRUCTION. <br />SIGNnTtJRE OF CONTfInCTOR Al9-MOPI.'[0>4ENT.OR OWNER OATE <br />XI �n,y..�n, Q, �.. �l'r 6/20/86 <br />NO. TYPE OF E�UIPMENT <br />A/C — A�HNDLG UNITS — H-P- <br />REFRIGERt.TIONUNITS—HP.EA. _ <br />BOILERS — B.T.U./HP. <br />GAS FIRED A.C. UNITS — P.T.U. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WAILHFATERS—B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLO(HESDflVEflS <br />VENTILATION F.4N <br />RANGEHOOD � <br />� W4TE1?4Ef.TEP • <br />WOC� ° 1?VE <br />METAL FIREPLAf.E 8 CHIMNEY <br />FIREPLALEINSERT <br />HEAT PUMP <br />GAS PIFING <br />E%HAUSTFAN <br />SUBTOTAL <br />PEPMIT <br />TOTALFEG <br />FEE <br />FEES <br />BUILDING <br />P�UMBING <br />MECHANICAL <br />INVESTIGATION FEE <br />STATE BUILOING SURCHARG <br />STATEENERGVSURCHARGE <br />DRIVEWAV PERMIT <br />$ <br />Sec.304(e) <br />FEE <br />FEE <br />TOTAL � I <br />PEflMIT VALIDATION <br />WNEN PFOPERLY V�LIDATED QN THIS SPACE) THIS IS YOUR PFRMIT <br />50 <br />50 <br />�" <br />N <br />N <br />CS� <br />� <br />