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`�'c`p,`."+r`.+"' —�ONSTRUCTIOP <br />ar� c� i � � ^ � � <br />�V��\+l.l. ��RM�� PERMIT NO. 120�3 <br />GTV HALL 259�87d5 <br />EVEHETT,WA90201 � COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING <br />OWtlER MAIL ADORE55 CITY ZIP PMONE <br />Fotis Koutlas 3826 Rucker Everett 98201 252-6273 <br />FNGHITEGi OR OESIGNEH MAIL RDDRE55 GRY ZIP PNONE <br />GENERALGONTPACTOR MPILA)JRE55 GITY ZIP PNONE ULENSEM <br />MECHANICRI LONiPACTOR MAIL AD�RESS GTY ZIP PHONE LICENSE i <br />PLUMBING CONTRAGTOR MAIL ADDRESS CITY ZIP PMONE LICEk3E I <br />Moon 17725 Simon Road Snohomish 98290 568-8856 <br />CLASS OF WORK ��7[� <br />O NEW ❑ AODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN � CWO� � FIREPLACE INSERT <br />f <br />USE <br />LOT _ OLOLN _OF <br />45?0 Grand <br />PLUMBING <br />TYPE OF FI7CTURE OR <br />BATHTUB <br />Z LAVATORYIWASHBASII <br />2 SHOWER <br />NITCHEN SINK 8 DISP. <br />j DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR OHAIN <br />VACUUM BREAKERS <br />ROOF DFAINS — RAINI <br />SINK �SEHVICE — BAR, <br />SUBTOTAL <br />PEflMIT <br />TOTRL FEE <br />SIZE OF <br />i. ENVIRONAIENTAL:,HECK LIST <br />2. BUILbING PLANS <br />7. FIRE H1'DRANT <br />4. FIPE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGe <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHE <br />I HEAEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVIuIONS 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 LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCT�ON. <br />SIGNATUR F CONTHACTO NORIZED ENT OATE <br />X 5/19/83 <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />AIR COND. UNITS — M.P. EA. <br />FEFRIGERATION UNITS — H.P. EA. <br />00 BOILERS — H.P. EA. <br />Q Q GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />OO WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES ORYERS <br />VENTILATIUN FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSER7 <br />HEAT PUMP . I <br />S "" <br />f <br />s 14 00 <br />IEAR YARD SETBACK <br />'ACANT SITE <br />VES _:NO <br />10. OF DWELLING UNITS <br />AAX.00C.LOAD <br />'IRE SPRINKLERS <br />IEOUIRED <br />'VES I�'.NO <br />SUB TOTAL S <br />PERMI7 S <br />TO7AL FEE f <br />FEE � RECEIP7 NO. <br />FEES I VALUATION I FEE <br />BUILDING S <br />PLUMBING L�S OO <br />MECHANICAL <br />OTHER <br />PENALIY U.B.C. <br />SEQ 903 lal <br />TOTAL I 14 I O 0 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) TMIS IS YOUR PERMI7 (Y') <br />Add to Permit #11�8��5 � ���.G 0— � <br />N <br />BY YOUR RECEIPT � <br />Ti�nN�: You <br />ADDRESS FILE I 9 6AY $ 3 <br />u <br />