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the ED�� o rONSTRUCTION p p <br />everett PERM!T PERMIT NO. 17984 <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL 6J PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CIIY ZIP PHONE <br />C.H. Quist 1557 164th NE v-7 Bellevue 98008 747-7418 _ <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CUY ZIP PHONE LICENSE II <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CIT- ZIP PHONE LICENSE II <br />Art's Elf Plumbing 102 Avenue D finmp Snohomish 98290 568-4237 ARTSP181CH <br />:LASS OF WORK <br />a NEW ❑ ADDITION <br />IALUATION OF WORK <br />)ESCRIBE WORK <br />Plumbing <br />1EAT SOURCE <br />❑ ELECTRICITY G GAS <br />❑ ALTERATION G REPAIR ❑ DEMOLITION L] BUILDING RELOCATION <br />❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BULDING <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 />SIGNATURE ONTR CT RIZED AG OR OWNER DAT <br />x -� <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT - BLOCK _ OF <br />JOB ADDRESS <br />7825 Larimer Rd. <br />PLUMBING <br />MECHANICAL — <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS — B.T,U./H.P. <br />SHOWER <br />5 <br />00 <br />GAS FIRED A'C. UNITS—B.T.U. <br />KITCHEN SINK d DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />11D <br />UNIT HEATERS —B.T.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />_ <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAI`! <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADFPS <br />WOOD STOVE <br />SINK (SERVICE — BikR. ETC.) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTAL FEE <br />S 10 <br />00 <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK SIDE <br />SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA VACANT <br />SITE <br />❑ YES El No <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST, <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ONO <br />INVESTIGATION FEE <br />Sec. 304(e) <br />STATE BUILDING SURCHARGE <br />03I3I/87 4%2 <br />IPM DOD41H4582 <br />(KU <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />S.H. <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />FLRG $1 <br />.00 <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT �- <br />00 <br />CT) <br />ADDRESS FILE <br />