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r <br />� <br />♦ <br />L <br />� <br />� <br />the Ecergreen , p N ST R U CT I O P <br />Ciiv pF � � � <br />everett PERMIT PERMIT NO. 126$3 <br />CITV HA'_L 259�87<5 <br />EVERETT. WA 98201 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUM8ING <br />OWNER MAILADDRE55 CITY ZIP PHONE <br />DUANE E. JACOBS, JR. 6410 HiGHi.AND DR RVF.RETT WA 9R20'i 455-R7QA <br />ARCMITECT OR DESIGNER MAIL AD�RE55 LITY IIP PNONE <br />GENb�ALCONTRRCTOR MRILADDRE55 CITY Z�P PHONE LICENSEI <br />MECHANIG�L CONTR�CiOR MAIL ADDRE55 CITY ZIP PNONE LICENSE I <br />Same <br />PLUMBING CONTRAGTOR MAIL ADDRE55 CITY 21P PNONE LICENSE � <br />f <br />❑ NEW ❑ ADDITION ❑ ALTEFATION ❑ REPAIR ❑ DEMOLIiION ❑ FENCE ❑ SIGN XX WOOD STOVE/FIREPLACE INSERT <br />Install wood stove <br />Kesiuence <br />LEGAL OESCRIPTION OF P� 2qTY �5 <br />LOT _ BLOLK _OF _ <br />6410 Highland DRive <br />PLUMBIN6 <br />NO. TYPE OF <br />BATHTUB <br />LAVATORY ryJASH BASIN) <br />SHOWER <br />KI7CHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASMER <br />WATER HEATER <br />URINAL <br />DPINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF DRAINS — fiAINLEADE <br />SINK (SERVICE — BAR, ETC.) <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />�. FIRE PROTECTION SYSTEM <br />�. <br />e. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUF AND <br />CORRECT. ALL PROVISIONS OF LANlS 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 LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIG RE OF CONTflAGTOR OR AIITHOHIZEO AGENT OATE <br />X�r.�n �_ �n1►�.Li�lk.. „i�aiss <br />MECHANICAL <br />FLE N0. TYPE OF E�UIPMENT FEE <br />AIR COND. UNITS — H.P. EA. <br />P.EFR�GERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIHED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALL HEATEPS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPOPATIVE COOLERS <br />CLOTHES DRYERS <br />S <br />S <br />S <br />ACANT SITE <br />;YES � NO <br />MA%.00G.LOAD <br />fFLC` i7 <br />APPR. FOR ISSUANCE BY <br />RANCaE HOOD <br />AIR HANDLINC UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL f <br />PERMIT f <br />TOTALFEE f <br />IFEE I RECEIPT NO. <br />FEES VALUATION FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAI 1] SO <br />OTHER <br />PENALTV U B.C. <br />SEC. 303 (a) <br />TOTAL 1 ] 5 � <br />PERMIT VALIDATION <br />WMEN PROPERl.V VALIDATED (IN TH�S4 I g 6 THIS I$ yOt�H,�EBA�T _—(t j_ <br />� 0 � � � U � <br />i.� <br />N <br />�-OUR REC[IPl''-'� <br />71-1ANK YOU <br />ADDRESS FILE <br />I 0 t�V 8 3 <br />� <br />� <br />J <br />J <br />