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d+r Errr�recn <br />everett <br />CITY HALL 259-8745 <br />�� �CONSTRIJCTlO� � <br />PER�'lIT PERMIT NO. 1565U <br />EVERETT. VJA 98201 � COMBINATION ❑ BUILDING ❑ MECHANICAL Q PLUMBING <br />OIVIlER 1AAIL ALOAE55 CIT" ZiP PHONE <br />MRS. Tf70MAS READER PO BOX 335 EVERETT WA 98206 252-6034 <br />NFGMITECTGr±�E[I�NER IAAILADflFE55 C�iY 21P PHONE <br />GENERAL CONTF0.GTOR IAAIL A�OPESS CITY ZIP PHONE LICENSE x <br />$.�%iE <br />MEGMnNICFL GONTR4CTOR MAIL ApORESS GTY ZIP PHONE LICENSE ♦ <br />PWMBING CONTRACTOP MAIL AODriE55 CITY ZiP PMONE UGENSE � <br />OF WOFN <br />❑ NEW ❑ AGDITION ❑ ALTERATION Q P.EPAIR ❑ DEMOLITION ❑ FcNCE ❑ SIGN ❑ WOOD STOVFJFIREPLACE INSERT <br />❑ON OF WORK <br />S <br />�ESCPIBE wORK <br />Replace water line <br />PPOPOSED USE OF 9UILOING <br />Residence <br />LEGAL �ESGFIPtION OF PROPERTY (SHOI <br />wr_s�ocrc_oc_ <br />JOB ADDRE55 <br />3908 tIoyt <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOI LET) <br />BATHTUB <br />IAVATGRV�WASH BASIN) <br />SHOW EF1 <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRY Tr7AY <br />CLOTHES WASHER <br />WATER HEATER <br />URIFAL <br />DRINHING FOUNSAIN <br />FLOOR DRAIN <br />VACUUN BREAKERS <br />ROOF DRAINS — RAINLEAOERS <br />SINK �SERVICE — BAH, ETC.) <br />SIDE YARD SETBACK <br />S�s TOTAL <br />PERMI' <br />TOTAL FEE <br />SiREETSETBACK <br />SIZE OF BLDG. NO OI <br />FIPC ZONE BASEh <br />APPROVALS <br />7. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRAOING <br />6.DRAINAGE <br />7. EN VI RON MENTAL I MPACT STAT <br />COPIESJ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TH[ 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 NGT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THC PROVISIONS 0� ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATUAE OF CbNiqACTOR ORTUTHORIZED AGENi OAiE <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERFTION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIF SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />' UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES ORVERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HAN�LING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE & CHIMNEV <br />FIHEPLACEINSERT <br />� <br />S <br />S <br />R!' `A <br />4CANT SITE <br />YES : NO <br />BV <br />8. HEALTii DISTRICT I � <br />APPLICATION ACC. BY PLANS CMECKED BV APPR. <br />FEES <br />BUILOING <br />PLUMBING <br />MECHANICAL <br />OTMER <br />PENALTV <br />FEE <br />SUBTOTAL 5 <br />PERMIT S <br />TOTAL FEE S _ <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />VALUA710N FEE <br />S <br />U.B.C. <br />SEC.303 <br />5 <br />TOTAL I I $ I QQ <br />PERMIT VALICATION <br />WMEN PROP6RLY VALIDATED �1N THIS SPACE) � HIS IS YOUF PERMIT <br />u�1t, gD05.00 - �`� <br />FlDDRESS FlLC <br />. r,�:�r-i, ; ' ' <br />. . � �}' �', � � <br />' � i._� uJ <br />