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t:5e Euergr.•en <br />CITY OF <br />everett <br />259-8745 <br />❑ DEMOLITION <br />� C�NST�UCTION � " <br />PEF�MIT PERMITNO. � �796 <br />❑ COMBINATION ❑ BUILDING �j MECHANICAL ❑ PLUMBING ❑ SIGN <br />O\'INEP MnILAD�RE55 CITV ur ..,��._ <br />Christian Armed Services Association P O Box 3012 EverPtt WA 9820'1 75a-0954 <br />ARCNITECTOl1O[SIGNER MAILADDRE55 CITY 21P PMONE <br />GENERAL CONifinCTOl1 h1AIL ADDRE55 CITY ZIP PMONE LICENSE � <br />MECMANICALGONTflAL�OP AIAILAD�flE55 CITY Z6' PnONE LICENSE� <br />Bergman and Sons Const 3702 214th SW Mountlake Terrace. Wh 9804'i REiicMG�2=�$j7_ <br />PWM�INGCONTRACTOR MPILAOORE55 CITV ZIP PNONE L16ENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUIIDING RELOCATION <br />S <br />OESCRIBE WOFN <br />Install fireplace insert. <br />MEATSOURC[ <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHEF <br />io* _ o�ocK _ <br />PLUMBING <br />TYPE OF FI; <br />WATER CLOSET (TOIL' <br />BAiHTUB <br />�AVATORYIWASHOA: <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWn$HER <br />LAUNL�RYTRAV <br />CLOTHES WASHEfl <br />ATT/CH <br />DRINKING FOUNTAIN <br />FLOOR OHAIN <br />BACKFLOY:PREVENTERS <br />ROOF JRAINS — RAINLEADERS <br />SR.V< �SERVICE — BAR, ETC � <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />OCf,UP�NCY4ROUP <br />NO OF STO(ilES <br />FIRE SPRINNLERS REOUIRED ❑ YES ❑ NO <br />APPLICAI <br />S.H. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAMc ?n BE TRUE AND <br />CORRECT. ALL PROVISIONS O� LAWS AND ORGINAIJCES <br />GOVERNIN6 THIS TYPE OF WOFK WILL 8E COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PEHMIT DOES NOT PRESUNtE TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE F'ROVISIONS OF ANY OThIER <br />S'.ATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />cicranriiarrxcnuinnf.inNAUT�bRiZEOAGEN1.oROWNER oaTE <br />X ,_�� <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />lV C— A/NN�LG UNITS — H P <br />REFRIGERATION UNITS — HP. EA. <br />BCILEFS — 8 T.UiHP. <br />GAS FIRED AC. UNITS — B7.U. <br />FOPCED AIR SYSTEMS — BSL. Id EA. <br />WALIHEATERS—�TL. M <br />UNIT HEATERS — B.T U M <br />EVAPORATIVE COOLERS <br />CLOTHESDRYERS <br />VENTILATION FAN <br />flANGEHOOD <br />WATER HEATEfl <br />WOODSTOV[ <br />METAL FIREPLACE 8 CHIMNEY <br />FlPEPLACEINSERT <br />HEAT PU61P <br />GAS PIPING <br />EXHAUSTFAN <br />VACANT SITE <br />❑YCS ❑NO <br />NO OF DWELLING 11NIT5 <br />ocC lono <br />or � v�nNs cNecK[o ov � n�rn vorv issun�+c[ or <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />°LANGHEGKNUMtltH <br />FEES <br />eui�owc <br />PLUMBING <br />MECHANICAL <br />INVESTIGATION FEE <br />STATE BUILDING SURCH�RG <br />STATE ENEFGY SURCHAfiGE <br />ORIVEWAY PERMIT <br />'EE RECEIPT NO. <br />VALUATION FE <br />S <br />Sec.304�e) <br />TOTAL I I . 30 I00 <br />PENMIT VALI�ATION <br />\YH[N PROPERLV VALIDATEO �IN THIS SPACE) THIS IS VOUR PeRM1T <br />�� <br />�7 <br />�� <br />Q) <br />r�_ <br />