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�he £rerkreen <br />UTY OF <br />everett <br />CITV MALL 2598745 <br />� �JNSTRUCTION� � <br />PERMIT Pe�Mir No. 15190 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING <br />OWNER MAILADDRE55 CITY ZIP PHONE <br />Duane L. Schizeman 4703 Greely Street Everett 98203 252-8006 <br />ARCNITEGT OR pE51GNEH MAIL A�pRE55 CITV ZIP PHONE <br />GENERAL GONTRAGTOR MAIL A�DRE55 CITY ZIP PMONE 4CENSE I <br />MEGM�NIG�L CONTRACTOR MAIL A�DRE55 LITY ZIP PNONE LICENSE � <br />Same <br />PLUMBING GONTRACTOR MAIL A�ORE55 CITY ZIP PMONE UCENSE � <br />❑ NEW ❑ ADDITION ❑ AL7ERA710N ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN � WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORN <br />f <br />Instalation of free standing stove <br />FOUR <br />LOT _BLOI'I( _OF <br />JOB ADDflESS <br />4703 Greely Street <br />PLUMBING <br />TYPE OF FU(TURE OR ITEM <br />WATER CLOSET (TOILET) <br />LAVATORY (VJASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLO7HE5 WASHER <br />WATER HEATER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />'JACUUM BREqKERS <br />HOOF DRAINS — RAINLEADERS <br />SINK �SERVICE — BAF, EiQ) <br />SUB TOTAI i <br />PENMIT f <br />TOTAL FEE S <br />;��.YES : NO <br />YES <br />APPROVALS <br />t. ENVIRONMENTAL CHECK LIST <br />2.8UILDING PLANS <br />3. FIRE HYDRANT <br />0. FIRE PROTECTION SYSTEM <br />5. GRAOING <br />8. DRAINAGE <br />'7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. <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 STPTE OR <br />LOCAL LAW REGJ�ILATING CONSTRUCTION OR THE <br />AGENT D�TE <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNI7S — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — 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 & CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL i <br />PERMIT S <br />TOTAL FEE i <br />ETBACK PLAN CHECK NUMBER PLAN C <br />FEE <br />FEES VALUIITION <br />LING UNITS <br />BUILDING S <br />'dD <br />PLUMBING <br />.ERS MECMANICAL <br />DATE OTHER <br />BY <br />RECEIPT N0. <br />FEE <br />17 I $0 <br />PEfJALTY SECv303 (a) <br />Totn� 17 50 <br />PERMIT VALIDIITION <br />WHEN PROPER�Y VALIDATED pN THIS SPA�E) THI$ IS V REHMIT Q <br />P`� �� <br />AGDRESS FlLE <br />r"'{ <br />i.i�i <br />i� ��I <br />�� <br />