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�pe E�•cr,�reen <br />Ciiv OF <br />everett <br />� CINSTRUCTIC N <br />PERMIT <br />PERM!T NO. �. 3 6 � 5 <br />CITY HALL 259�8745 <br />EVERETT.WA9B201 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL/•D�RESS GTY ZIP PMONE <br />Dorn Jellison 806 High Street Everett 98203 259-1373 <br />qRCHITEGT OR OESIGNER MAIL AUDRESS CITV ZIP PMONE <br />GENERALCONTRPGTOR <br />MAILADDRESS CITY ZIP PHONE I.ICENSEI <br />Lee Construction 832 52nd Street Everett 98203 252-9345 <br />MECHANICAIGONTRACTOR <br />MAIL AO�RESS CITY 21P PHONE LICENSE M <br />PLUMBING GONTRAGTOR <br />MFIL ADORE55 UTY 21P fHONE UCENSE � <br />s <br />O NEW O ADDITION }� ALTERATION O REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ W�OD STOVFJFIREPLAGE INSERT <br />14,013.00 <br />and alteration to <br />EGAL OESCRIPTION OF PPOPERN �SHOW BELOW OR ARAGH FOUR <br />LO7� z� 3 i BLbSK 4 oF Smyth Land Co. 2nd <br />16.17 <br />4006 High Street <br />PLUMBINO <br />NO. TYPE OF FIXTURI <br />j WqTERCLOSE7�TOILET) <br />�WASH <br />SHOWER <br />KITCHEN SINK 8 OISP. <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER MEATER <br />URINAL <br />�RINKING FOUN7AIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL f <br />PENMIT t <br />TOTALFEE S <br />residence-Chip <br />FEE <br />2 00 <br />2 00 <br />2 00 <br />YES NO <br />7YPE OF CONST. �OCCUPANCV GfiOUP NO. OF DWEL <br />SIZE OF BLDG. NO. OF STOHIES MA%. OCC. L( <br />FIREZONE BASEMENT R OUSRED KI <br />YES :.NO <br />APPNOVALS BY <br />1. ENVIRONMENTAL CHECK LIST <br />2. eUILDING PLANS i N <br />3.FIREHYDRANT '' <br />4. FIRE PROTECTIQN SYST <br />y5. GRADING <br />_FyDRAINAGE ' � `-^ <br />.7.ENVIRONMENtALIMPACT 7ATEMENT <br />'1l.HEALTH�DIS1iUCT .� <br />_�ooi icennN AC.G BV —PLANS CNECKED BY APPR. FOR I'� <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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL _LA� RE���� CONSTRUCTION OR THE <br />PERFORNIA E OF N UCTION. <br />SIGNATUR�bF 0 R T TM IZEO AGENT 0 TE <br />X / i [i �t/11� % %0�� <br />NO. TYPE OF EOUIPMEni <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 E <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. �+1 <br />EVAPORA7IVE COOLERS <br />CLOTHES DRVERS <br />VENTILATION FAN _ <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />S70VE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTMER <br />SUB TOTAL S <br />PERMIT s <br />TOTAL FEE S <br />PLAN CI <br />FEE <br />VALUATION <br />s14,000. <br />RECEIP7 NO. <br />FEE <br />104 50 <br />14 00 <br />PENALTY SEC.7091a) _ <br />118 50 <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED QN TMIS $PPCR) THIS,'ISIYW{� P�FMIT ;i�.� <br />t .�I . 4 U �-1 <br />i C� <br />l`�' <br />�".,, �i I •. . <br />0Y , • ' U <br />ADDRESS PILE <br />�i ,. ��-�- � �i <br />� <br />z <br />0 <br />� <br />m <br />o--� n-� <br />-� � <br />.. -� <br />tn x <br />m <br />v <br />cv <br />m o <br />c'� <br />O 3 <br />m <br />i1 <br />m <br />�--� <br />.0 2 <br />D -1 <br />rx <br />.. .� <br />1 N <br />K <br />O � <br />T D <br />--i m <br />m �-+ <br />� <br />o r <br />C N <br />� N <br />'m <br />2 f7 <br />�m <br />D <br />A <br />1 <br />S <br />D <br />Z <br />--I <br />S <br />N <br />2 <br />O <br />--1 <br />C') <br />m <br />