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d�r L'�'erlreen �p N ST R U CT I O�' <br />Ci�vG� <br />everett PERMIT PERMIT NO. 13O�1� <br />CITY HALL 259�8745 <br />EVERETT, WA 98201 ❑ COMBINATION � BUILDING �XMECHANICAL ❑ PLUMBING <br />OWNF.fl MPILADDRESS pTY 21P PHONG <br />Image By Blackburn 3215 Kromer Everett 98201 252-5391 <br />ARLMITEGT OR OESIGNER MAIL AODHE55 CITV ZIP PMONE <br />GENEFRL CONTR�CTOP MAII ADDRE55 QTY 21P PHONE LICENSE I <br />Same <br />MECHANICAL CONTPACTOR MAIL ADORESS QTV ZIP PHONE LICENSE � <br />PWM9ING GONTRACTOR MAIL ADPNE55 QTY ZIP PMONE IICENSE � <br />s <br />❑ NEW ❑ ADDITION ❑ AL7ERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN O WOOD STOVEIFIREPLACE INSERT <br />Studio and workshop <br />L0T__BLOCN__OF <br />2907 Hewitt <br />PLUMBINO <br />NO. TYPE OF FIXTI <br />WATEfi CLOSET (TOILEn <br />BATHTUB <br />LAVATORV ryJASH BAS <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER MEA7ER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRRIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK ISERVICE — BAR, ETC.) <br />TOTAL <br />TOTALFEE <br />NO. <br />1. ENVIRONAIENTAL CHECK LIST <br />2. BUILDING PUNS _ <br />3. FIRE HYDRANT <br />4. FIRE PROTeCTION SYSTEM <br />5. GRADING <br />6. DRAINRGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEALTH DISTRIC7 <br />aaP�ICAiION ACC. BY PLANS CHE <br />BV <br />FEE <br />� <br />S <br />S <br />REAR YARD S' <br />VACANT SITE <br />,:YES �.�.NO <br />NO. OF D\YEL <br />MA%. 000. LC <br />FOR <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 />WHETHEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMA�I CE OF COt�ISTRUCTION. <br />� ��.. iocnc waenrna n��uTMOR12ED AGENT D�TE <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P.EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCEO AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTV <br />TOTAL <br />SUB TOTAL ! <br />PERMIT 3 <br />TOTALFEE f <br />PLAN CI <br />FEE <br />VALUATION <br />S <br />FEE <br />RECEIPT NO. <br />FEE <br />13 100 <br />PERMIT VALIDIITION <br />WHEN PROPERLY VALIDATED �1N THI� gPSC�) THI�9T'�U! PeWM1T � <br />U J U <br />O <br />M <br />= :�, r _c;-iPT � <br />, �.A.� ..\ `IrC. U <br />ADDRESS FILE <br />2 J FE3 8 �I <br />n <br />