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,,��.�,�.,�,��„ �OI��TF�IJ C�TIO N . <br /> ��r��F <br /> everett PERMIT pERMIT NO. OH932 <br /> CITY HALL 253�Bia5 <br /> eveaerr,v+a 9ezo+ ❑ COMBINATION ❑ BUILDING A� MECHANICAL PLUMB�NG <br /> 0'..YER NAI�A[JGPt55 PTY ZIP PnOt1' <br /> Harold S. Mansfield 7417 Jefferson Avenue Everett 98203 355-5975 <br /> 2��p'.rtCCiOR�ESiGe�ER IAFILADDRE55 CI1T Z�� PHONE <br /> GEOE�AL WNTflACTOP MAILAD�RE55 CIiY ZIF PHOGE LICCI6E I <br /> Same <br /> NEGNAMULCONLRACTOF MAILADDRE65 Cltt ZIP GN@!E LICENSEI <br /> PWIABINGC@lTPhLiOR IdAILADOPE55 CITY ZiP PMONE IICEN5E1 <br /> CLASS OF WORK <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIP ❑DEMOLITION ❑FENGE ❑SIGIJ GFRAGE <br /> VAWATION OF\VORK <br /> 5 <br /> DESGRiBE w0 K <br /> insta 1 wood burning stove <br /> raocoseo use oF ouaou:c <br /> s ingle £amily I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �ccn�oescaianonoFPaoaea*v�sHoweE�ov+onarrnc�iFouacoriEs� PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THiS <br /> ior eiacK_oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PRO- <br /> VISIONS OF ANY OTHER STATE OF LOCAL IAW FEGULATING <br /> CONSTRUCTION OR THE PERFORMANCE/OF CONSTRUCTION. . <br /> SiC'�TURFOfGGRiMCt jl1A'JiHOFREUAGEN��7/� DAii / � <br /> JO�ADDAE55 / <br /> 7917 Jefferson Avenue X . �/�� Q'`f(� // �E�1/ <br /> , � i <br /> PLUMBING MECHANICAL _- _ <br /> NO. TYPE OF FIXTL'RE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLO_ET(TOILET) AIR COND.t1N1T5—H R EA. <br /> REFRIGERATION 11NITS—HP.EA <br /> BATHTLJU <br /> LAVATORY IWAShI�ASIN) BOILERS—H.P.EA. <br /> SHOYlER <br /> GAS FlRED 4.C.UNITS—TONNAGE EA. _ <br /> HITCNEN SINK&DISR FORCEO AIR SYSTEIdS—B.TL. bl EA. <br /> IYALL HEATERS—�1.�. N' <br /> DISNWASHER _ <br /> — UMTHEATERS—BT.U. M <br /> LAUNDRY TRAY EVAPOFATNL COOLERS <br /> CLOTHES YJASMER __ QOTHES DRVERS <br /> WATER HEATER <br /> - VENTILATION FAN <br /> URINAL <br /> DRINKING FOUNTAIN RANGE��OOD <br /> AIR HANDUNG UNIT— �F.M. <br /> FLOOR DRAIN <br /> V�CUUM BREAKERS 1 STOVE <br /> ROOF�RAIi�S—RAINLGADERS ME1AL FiREPLACE 8 CHIMNEY <br /> SINK�SERVICE—BAR,ETGJ <br /> SUBTOTAL <br /> suerora� t 4 50 <br /> PEHMIT f PEfiM1T f 3 00 <br /> TOTALFEE f TOTALFEE _ <br /> PLAN GH[CK FEE <br /> SIDF.YARU SEi9AGK STREET SET�ACK HEAR YARD SEiDACK PLAN CHECK NUM�EF qEGEIPT NO <br /> FEE <br /> US[ZONE ���AREA LAY 5'�T S]NO FEES VALUATION FEE <br /> TYPE OF GONST. OCAUPANCV GROUP NO.OF DWEIUNG UNIiS <br /> 6UILDING � <br /> SIZE OP BLDG. ' N0.OF STORIES MA%.OCC.LOAD <br /> PWMBING <br /> FIRE ZONE BASEMENT pEOUIRED KIERS MECHANICAL �I S O <br /> ❑YES C1N0 <br /> qppqpyp�s BY DATE OTNEP <br /> L ENVIRONMENTALCHECKLIST PENALTY U.B.C. <br /> SEC,303�a) <br /> 2. BUILDING PLAN$ ] S O <br /> TOTAL <br /> 3. FIRE NYORANT <br /> a. FlhE PROTECiION SVSTEM PERMIT VALIDATION <br /> WHLN PROPERLY VALIDAT[U�M THIS SPACE)THI515 YOUR PERMIT <br /> 5. GRADING �, � � ( ',� � 7 C �� _ �a <br /> ! �iy <br /> o D��INAGE � <br /> ]. [NVIRONMENTAL IMPACT STATEMENT � <br /> o nen�n�nisraicr ' �� i:� O <br /> � �� <br /> APPLIC/+TION ACG.�Y PIANS CHLCKED BV APPR.FOR ISSUANCE�Y � <br /> V.C. ' <br /> nooaes, Fi�� � i ,�,.3 � I <br /> a � � , <br />