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the f,bergreen <br />CITY OF <br />everett <br />259-8745 <br />❑ DEMOLITION <br />OWNER tq op —.LnuunoJ <br />Mak 6Bzcig¢ Sly 3419 Hoyt 252-9400 <br />f `ONSTRUCTION - PERMIT PERMIT NO. 17958 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />AHI.MIIGI.I UN UtJIUN[II <br />f.WIL PUVIICJJ <br />I:IIT <br />LII' <br />iNUNL <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE II <br />Natural Gas Equipment 1625 East Marine View Dr. Everett 96ZU1 zzozaaz NATURGE321K4 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK <br />Install hot water tank, Paynefurnace, 75M BTU <br />HEATSOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />single family residence <br />I 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 />SIGNATUREOF C TBACTpR. AUTHORIZED AGENT. OR OWNER DATE <br />X' <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FUUR COPIES) <br />LOT _ BLOCK _ OF <br />JOB ADDRESS <br />3419 Hcyt <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />A/C - A/HNOLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T.0 /H.R <br />SHOWER <br />GAS FIRED A . UNITS — B T.U. <br />KI'CHEN SINK & DISR <br />F )RCED AIR SYSTEMS — B.T U. M EA. <br />DISh'NASHER <br />WALL HEATERS — B T L. M <br />LAUNDRY TRAY <br />1 <br />UNIT HEATERS — B.T.U. 75 M <br />9 <br />00 <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL a <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVE ITERS <br />WATER HEATER <br />6 <br />50 <br />ROOF DRAINS — BAR (LEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. I TC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />$ <br />SUBTOTAL <br />15 <br />SO <br />PERMIT <br />S <br />PERMIT <br />I I. <br />TOTALFEE <br />S <br />TOTALFEE <br />30150 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECUPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />LIYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />_ <br />MAX OCi LOAD <br />MECHANICAL <br />30 <br />50 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />.3SBC. M11': <br />`Y <br />P. <br />STATE BUILDING SURCHARGE <br />1100017958 <br />STATE ENERGY SURCHARGE <br />&LH S` <br />A� <br />' TF- <br />APPLI ;ATION ACC BY <br />M.M. <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />30 <br />50 <br />o[o Y•T VAI InenON <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />co <br />1-0 <br />m <br />L` <br />t— <br />ADDRESS Fli c <br />�o <br />