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7Ge Ll�rrtireen <br />�",°: ' �O�fSTRlJ�TIr �' <br />evere�t ���MI� PERMIT N0. 1376� <br />CITY HALL 259�8745 <br />EVERETT,YlA98201 � COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUM8ING <br />OT/NEP ldqILA00RE55 GITY ZIP PHONE <br />Wilma J. Dohlin 627 Madison Everett 255-1002 <br />ARCMIiEGT OR DESIGNER h1AIL ADDRE55 Gtt ZIP PMONE <br />GENERAL GONTRAGTOR MAIL AOORESS GITY ZIP PMONE LICENS: M <br />MECMANICAL CONTRAGTOR IAAIL AODFESS CITY IIP PHONE L�ENSE � <br />Valley Natural Gas 519 S.E. Everett Mall Way Everett 353-3535 <br />PLWdBING CONTflACTOR MAIL ApDFE55 GTV ZIP PHONE UCENSC � <br />❑ NEW <br />VALUATION OF WOfiN <br />1 <br />OESCRIBE WORK <br />PPOPOSED OSE OF BUIL�Ii <br />LEGAL �ESGRIPTION OF PI <br />LOT BLOCN_ <br />JOB ADDRESS <br />627 Madison <br />PLUMBING <br />❑ ADDITION O ALTEBATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVFJFIREPLACE INSERT <br />NO. TYPE OF FIXTURE OR ITEM <br />WATERCLOSET�TOILEn <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />K�Tr11LN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR �RAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEA�EFS <br />SINK (SERVICE — BAR, E7C.) <br />SUB 70TAL <br />PEflMIT <br />TOTAL FEE <br />NU.OF <br />FIRE <br />1. ENVIRONMENTAL CHECK LIST <br />2. �W LDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. ORAINAGE <br />7.ENVIFONMENTALIMPACTSTA"i <br />0. HEALTH DISTRICT <br />FEE <br />�`I <br />� <br />REAR VAqD <br />"-:VES L:NO <br />NO. OF DWEL <br />YES -NO <br />IY DATE <br />PLANS CHECKED 6V I APPH. FOq <br />I HEREBY CERTIFY THAT I N.4VE READ AND EXAMINED THIS <br />APPLICATION AND KNOV�' THE SAME TO BE TRUE AND <br />CORRECT. AI_L PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIEf) WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTINu OF A <br />�ERMIT DOES NOT PRESUME TO GIVE AUTHORITYTO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPT[ OR <br />LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br />PERFORMANCE OF CON�TFULTJON. <br />X �� //-' �i��`�./.. <br />tdF�1ANICAL.%� 5,"�•� <br />AGENi DAT <br />8/13�84 <br />AIF CONJif UNITS — H.P. EA. <br />REFRIGERATIOIJ UNITS — H.P. EA. <br />�OILE9S — H.P. EA. <br />GAS FIRED A.C. UN�TS — TONNAGE EA. <br />FORCED AIR SYSTEMS — �.T.11. 1.1 EA. <br />WALL HeATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANOLING UNIT — GF.M. <br />STOVE — WOOD <br />AIETAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />BUILDING <br />PLUtdBWG <br />1dECHANICAL <br />OTHER <br />PENALTY <br />SUB 7QiAL S <br />PEFMIT S <br />TOTAL FEE 5 <br />PLAN CI <br />� FEE <br />VALUATION <br />5 <br />U.B.C. <br />SEC. 303 (a) <br />FEE <br />RECEIPT NO. <br />FEE <br />TOTAL I I ZO I 5� <br />PEfiM1T VALIDATION <br />WHEN PROPERLV VALIDATED (W iH�S+SPAQE) THI5,1 Y P R�d1T {V <br />J:'/� .x,�i��.�l1— « <br />N <br />M <br />� -_ r <br />_'s: i.::C;,_I�T �' <br />�•i � U <br />_.'. 1i <br />� � , <br />H ' <br />,y �,. <br />H � <br />� _ <br />C' <br />O <br />C [ <br />C7 � <br />.� : <br />� F <br />n <br />� ' <br />:r , <br />N . <br />�� <br />f;'' <br />`; . <br />