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�� r"'JNSTRUCTION � '� <br />a1v oF <br />everett PERMIT PERMITNO. i �940 <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBIWG ❑ SIGN <br />CWNEN MPILAUpRE55 ;;ITY ZIP PHONE <br />Jim McGraw 1340 Madrona Ave Everett, WA 98203 258-9384 <br />APCNITECT OR DESIGNEN MAIL AODRE55 CITY ?IP PHONE <br />GENEM�CONTRACTOfl MAILqODRESS C�TY 21P PHONE LICENSE� <br />MECMPNIC�L CONTRAGTOR MnIL q00PE55 CITY ZIP PMONE LICENSE � <br />Valley Natural Gas 1132:i Hwy 99 Everett 98204 355-773U VALLENG153Li <br />PLUMBINGCONTNACTOH MAILApDRE55 CITv ZIP PHONE LICENSE� <br />GLASSOF WORN �� <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ pEPAIR <br />VFLURTION OF WORK <br />b <br />OESCRIBE WORN — <br />Install furnace / Install water heater <br />HEAT SOIIPCE — <br />❑ ELECTRICITY O GAS ❑ WOODSTOVE <br />Single family residence <br />LEGAL DESCRIPT�ON OF PROFEHTY �SHOW OE�OW OR ATtACH FOUR COPIES� <br />LOT _ ALOCN _ 04' _. <br />1340 Madrona Ave <br />PLUMBING <br />TVPE OF FII(TUHE <br />WATER CLOFET (TOILET) <br />BATNTUB <br />LAVATORV(WASH BASIN) <br />SHOWEH <br />KITCHEN SINK 8 OISP. <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />UHINAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />ROOF DRAINS — � <br />SINK ISERVICE — <br />❑ DEMOLITION <br />❑ OTHEH <br />❑ BUILDING flELOCATION <br />I HEREBY CERT"IFY 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 !1EREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />V�OLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW FiEGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CUNSTRUCTION. <br />SIGNATUPi: OF WNTRyO[OR. AUT/R`ql].EO AGENT, OR GWNF'P DRiE <br />FEE NO. TVPE OFEOVIPMENT <br />A/C — A/HNDLG UNITS — H.P. <br />REFRIGERATION UNITS— H,P. EA. <br />BOILERS — B.T.0 M.P. <br />GAS FIRED A�C. UNITS — B.T.U. <br />1 FCRCEDAIRSYSTEMS--D.T.U.ZOOMEA. <br />WALLHEATEPS—B.T.U. M <br />UNIT MEATF.RS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER MEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIf.iNEY <br />FIREPLACEINSERT <br />MEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL s <br />PENMIT $ <br />TOTALFEE S <br />BEAR SETBACN SIDE $ETOACK <br />LOT AI1EA <br />VnC�NTSrtE <br />❑YES ❑NO <br />OCCUPANGV GflOUP NO Oi DWELLING <br />SI2EOF6lUG. NOAFSTOPoES <br />APPUCATIONACC.BY I PLANSCMECeEDPY <br />M.M. <br />MA%. OCC. LOAD <br />APPR. FOR i55UANCE OY <br />SOBTOTAL <br />PERMIT <br />TOTALFEE <br />PLAN <br />FEES <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />INVES7IGATION FE[ O: <br />S7A7E BUILDING SURCHAqGE �. <br />STATEENERGYSURCFIARGE � <br />�RIVEWAY PERMIT <br />TOTAL <br />RECEIPT NO. <br />WHEN PRppERLV VALI�ATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />r,,;:���s:. Fii r <br />301U0 <br />7 <br />