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rhr Erer�reen �� � O N 5T R U CT 10 � � <br />otv G: <br />everett p����T PERMIT NO. �`� -=� <br />CITY HAiL 259�8745 <br />eveReTT,wneezai ❑ COMBiNATION `� BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OLYNER MAILApOFE55 GRY ZIP GHONE <br />EVERETT CLINIC 3912 COLBY AVENUE EVEREPT 1VA 98201 259-0966 <br />ARCMREGi OR �ESiGlJER MAiL f00flE55 G'r ZIP PHONE <br />GENERAL CONTRALTOR M1IAIL AODRE55 GIiY LiV PNONE LICENSE � <br />�LLERBE BLDRS, INC. PO BOX 1891 Everett WA 93206 259-G5fi3 <br />MECHANICAI CONTRSGTOfl MRIL ADOPE55 GITV ZIP PHONE �IGENSE • <br />PLUMBING CONTRFCiOR MAR qODRESS CITY ZIP PHONE �ICENSE: <br />S <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � DEMOLITION ❑ FEIJCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />Deraolish single fam� residence <br />LOT]-�� dIOCK 6 OF <br />doe nooaess <br />P:UMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />W ATER Cl OSET (TOILEn <br />BATHTUB <br />LAVATOR�(WASHBASIN) <br />SMOWER <br />ni icntn smn s msr. <br />DISHWASHER <br />IAUNDRVTRAY <br />CLOTHES WASHER <br />WATER 4EATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF �RAINS — RAINLEADERS <br />SINK �SEfl\9CE — BAR, ETQ) <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE E <br />FEE <br />VACANT SITE <br />I VES :INO <br />� �.VES ..NO <br />APPROVALS BY <br />L ENVIRONMEN7AL�CHECK LIST <br />2. BUILOING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SVSIEM <br />5. GflADING <br />E. DRAINAGE <br />7. ENVIHONMENTAL IMPACT STATEMENT <br />8. HFALTH DISTRICT _ <br />ACC.BY I PlANS CHECKED 9Y IAPPR.FOR <br />I H1=RFBY CERTIFY THAT I HAVE READ AND EXAMINcD THIS <br />API'LI�ATION AND KNOW THE SAME TO BE TRUE AND <br />CO��RECT. ALL PROVIS�ONS OF LAVJS AND ORDINANCES <br />GOJERNING THIS TYPE OF WORK WILL BE COMPLIEC WITH <br />WHETHER SPECIFIED HEREIN OR NGT. TfiE GRANTING OF A <br />PEFiM1T DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW R�GULATING CONSTRUCTION OR THE <br />PEfiFO�MANCE OF CONSTRUCTION. <br />SIG�ATURE F GU 1RACiOR OF AIRMORIZED 4GENT DFTE <br />X � � �� _ fi/d/RS <br />AIR COND. UNITS - N.P. EA. <br />REFRIGEFiATION UNITS — H.P EA. <br />BOILERS — H.P. EA. <br />GAS FIAED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — �.T.U. M EA. <br />VdALL HEATERS — B.T.U. M <br />UNIT HEl.TERS — B.T.U. M <br />EVAPORpTIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE— WGOD <br />METAL FIREPLACE 8 GHIMNEY <br />FIREPLACE INSERT <br />HEaT PUMP <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />PLAN C <br />I FEE <br />FEES VALUATION <br />RECEIPT NO. <br />FEE <br />BUILOING E �� �Q <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY U.O.G. <br />SEC. 303 la� <br />TOTAL OO OO <br />PENMIi VA�IDATION <br />WHEN PROPERLY VALIDATEO QN THIS SPACE� TY.IS IS YOUfj-PEFMIT �, <br />I --N, <br />� <br />�' <br />BY '� <br />ADDRE55 FILE <br />