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�,�E��° � C'�NSI"Rl1CT[C)!�! --- '�. <br /> e�erett PERMII PERMITNO. 20`�� � <br /> 259 -8745 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ 9UILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MMlq00RE55 CITV plP PMONE <br /> John Grokhowsky 29 E. Intercity Ave. Everett 98204 353-2736 <br /> qRCM1TECiOR�ESIGNER MAILADORE55 LITY TIP PNONE <br /> GENEt1ALCONTRACTOR MAILA�pRE55 CIiY ZIP PNONE LICENSE• <br /> MECHRNICAICONTRACTOR MAILPoOR[55 GITY ZIP PMONE UCENSE• <br /> owner <br /> PLUM�ING CONTRACTOR MAIL POOFE55 CITV ZIP PIION[ UCENSE• <br /> CLASS OF WORN <br /> ❑ NEW ❑ A�DiTION ❑ ALTERATION � REPAIR ❑ DEMOIITION ❑ BUILDING RELOCATION <br /> VALURTION OF WORK <br /> g <br /> �ESCRI�E V.'O�iN . <br /> Existing woodstove inspection. <br /> MEATSOURCE <br /> ❑ ELECTRICITY ❑ GAS ❑ WOOUSTOVE ❑ OTHER <br /> PROPOSEO USE OF 6UILOING <br /> ! HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Sin le famil residence APPLICATION AND KNOW THE SAME TO 9E TqUE AND <br /> LEGALOESCPIPTIONOFPROPERTY�SMOWBEIOWOf1ATTACMFOl1RCOPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> wr_awcK _oF. GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT. THE GRANTlNG OF A <br /> PERMIT DOES NOT PRESUME TO GIVE AUTHORI7Y TO <br /> VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br /> . STATE OR LOCAL Li�W REGULATING CONSTRUCTiON OR <br /> THEPERFORMANC FCONSTRUCT N. <br /> JO�F�pRF55 � SIGN l E OF CON ROCT .4Ut110NZF0 A NT i VNER /OATE <br /> 29 E. Intercit X �t7'-' <br /> PLUMBING MECHAN AL <br /> NO. TVP[OF FIXTUflE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AMNDLG UNITS—HP. <br /> BATHTUE REFpIGERATION UNITS—HP.EA. <br /> LAVATORV(WASH BASIN) E301LER5—B.T.0 MP. <br /> SHO�YLP GAS FIREO A f..UNITS—B.T.U. <br /> KITCIIEN SINK 8 OISP. FORCEO Alfl SYSTEh15—3.T.U. M EA. <br /> DISHWASHER WALLHEATERS—�.T.U. M <br /> LAUNDRYTRAV UNITMEATERS-9T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLEf?S <br /> URINAL CLOTHES DRYERS <br /> �RINKING FOLINTAIN VENTILATION FAN <br /> ROOR DPAIN RANGE HOOD <br /> ❑ACKF�0INPREVENTERS WATERHEA7ER <br /> ROOF�RAINS—IiAiiJI.EADEf75 1 WOOD STOVE (�_ <br /> SINK(SERVICF—�AR.ETCJ METAL FIFEPLACE 8 CHIMNEY <br /> FIREPLACE INScRT <br /> HEATPUMP <br /> GAS PIPING <br /> E%HAUSTFAN <br /> � <br /> SUUTOTAL 5 SUBTOTAL� <br /> PEflM1T S PER " <br /> TOTALFEE S TOT <br /> G�VONTSElOACN REARSETOnCrc 9DESET[3nCrc P�qWCHECKNUM�ER F � R EIPTNO. <br /> USE ZONE lOT MEA <br /> vncnHtsrte FEES VALUATION FEE <br /> ❑YES ❑NO <br /> TYPEOFCONSi OCCUPANCYGROUP NOOF�WELUNGpNITS BUILDING S <br /> PLUMBING <br /> SiZE OF D�OG NO OF STORiES MAK OCC LOPD <br /> MECHANICAL <br /> INVESTIGATION PEE Sec.904�e) <br /> FIHE SPRINNlERS REOUIREO ❑YES ❑NO <br /> STA7E 9UILDING SURCHARGE <br /> STATEENERGVSUFCHARGE <br /> AP{'UCATIONACCOY PI�N$CI�ECN[Of3Y �PPRfORI55llANC[AY <br /> DRWEWAV PLRM17IT <br /> S.H. TOTAL 30 00 <br /> PERMIT VALIDATION <br /> WIiEN PROPERLV VALIDATED pN THIS SPACE�1H151S VUUfi PEfiMIT <br /> �.� <br /> � <br /> �" <br /> 0 <br /> N <br />