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(hc Llrr,�rren Jp N ST R U CT I O �, <br />CitV O� <br />everett PERMIT PERMIT NO. 12971 <br />LITV HAL1259�8745 <br />EVERETT, WA 98201 [j COMBINATION ❑ BUILDING �7i MECHANICAL ❑ PLUMBING <br />OWNER MAILAO�HE55 Cli\ ZIP PHONE <br />Daniel 8Y Buckingham 8014 Hamlet Lane Everetl: 98203 355-9265 <br />PPGHITECT OR OESIGNER MRIL AD�RESS LITY ZIP PHONE <br />GENERAL CONTPRCTOR <br />MAIL PDORE55 pTY 21P �MONE LILENSE M <br />MEGMANICAL CONTRRCTOR MAIL AODRE55 <br />GITY ZIP PMONE LIGENSE � <br />Sdiile ��TY ZIP PNONE IICENSE � <br />PLUMBING CONTRRCTOR MAIL ADORE55 <br />❑ ryEW ❑ ADUITION ❑ ALTERATION ❑ REPAIfl ❑ OEMOLITION ❑ FENCE � SIGN ❑ WOOU STOVFJFIREPLACE iNSERT <br />S <br />LOT _BLOCK _OF <br />lOB AODRE55 <br />8014 Hamlet Lane <br />PLUMBIN� <br />N0. TYPE OF FIXTURE OR <br />W ATER CLOSET (TOILEn <br />6ATMTUB <br />USE <br />SHOWER <br />KITGHEN SINK 8 DISP. <br />�ISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WA7ER HEAiER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VAGUUM BREAKERS <br />�ROOF ORFINS — RAI <br />SINK (SERVICE — BP <br />OF <br />ETC.) <br />1. ENVIRONA7ENTAL CHECK LIST <br />2. BUILDING PLANS <br />9. FIRE HYORANT <br />4. FIRE PROTECiION SYS7EM <br />5. GFAOING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTA' <br />ACC.BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />CORRECTI�ALL PROVIS ONS OF LA NS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPIIED WITH <br />P RMIT DOES NO'TIPRESUMEI TO GIVE AUTHORITY TO V O�ATE <br />OR CANCEL THc PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFO NCE O ONSIRUCTION. <br />S,GNAT E OF UNTF� AUTMOj�I2E0 RGENT'� Z���84 <br />�� l� <br />MECHANICAL ' <br />FEE N0. TYPE OF EOUIPMENT <br />AIR CONO. U�ITS — H.P. EA. <br />REFRIGEflAiION UNITS — M.P. EA. <br />BO�LERS — H.P.EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M _ <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLEFS <br />CLOTHES DRYEPS <br />VENTILATION FAN <br />RANGEMOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD _ <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />TOTAL = <br />MIT S <br />pL FEE S <br />SETBACK REAR YARDS <br />_q VACANT SITE <br />: �.YES i�NO <br />1NCY GROUP NO. OF DWEL <br />cinRIFS MAX. OCG LC <br />BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />SUB TOTAL f <br />PERMIT s <br />TOTALFEE f <br />PLAN CI <br />FEE <br />VALUATION <br />b <br />qE�EIPt NO. <br />FEE <br />PENALTY SEC.90JIa) <br />TOTAL 1 17 SO <br />PEHMI7 VAIIDATION <br />WHEN PROPERLY VALIDATED pN Tlil �S� 5 EI THI$ IS � UR PE�RMIL � <br />� 0 U � j <br />N <br />, �.,_ RcCEIPT •-� <br />� ;, <br />, � �,��ae Yc; u <br />nDDRESS FILE <br />- g rEa 8 � <br />