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d�rL•l•er�reen � �ONSTRUCTIO� <br /> atr r�� � <br /> everett PERMIT PERMIT N0. 16112 <br /> CITY HALL 259B745 <br /> EVERETT,WA 98201 � COMBINATION ❑ BUILDINO � MECHANICAL ❑ PLUMBIN(i <br /> OWNEN MRIL ROORE55 CITY 2IP PMONE <br /> Cara M. Maddy 721 Pecks Drive �erett, WA 98203 355-9092 <br /> ARCHITECi OR OESIGHER MnIL A�DRESS C17Y 21P PMONE <br /> GENER�L LONTRACTOR MAIL�D�RE55 pTY ZIP PMONE IILENSE� <br /> MECNANIC�L CONTRAGTOR MAIL ADDRESS C�T'� 21P PNONE LICENSE� <br /> PIUMBMG CONTR�CTOR MAI�AO�PE55 dTY ZIP PNONE LICENSE I <br /> CLASS OF WOFI( <br /> O NEW ❑ AO�ITION ❑ ALTERATION ❑REPAIR O DEMOLITION ❑ FENCE ❑ SIGN Q WOOD STOVFJFIREPUCE INSERT <br /> VFLUATION OF WONK <br /> f <br /> DESGRIBE WORK <br /> Install wood stove <br /> PROFOSEO USE OF BUILOIHG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Single family residence qppLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAL DCSGRIPTION OF PROPERTY(SMOW BELOIY OR AnA�H FOUN COVIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> LOT_BLOCK_OF 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 REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCT!ON. <br /> JOB AOORE55 SIGNATOPE OF GONiRACTOR OR AUTNOR2F0 AGE UATE <br /> 721 Pecks Drive <br /> X � 22786 <br /> PLUM81Nf3 MECMANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILE7) AIR COND.UNITS— H.P.EA. <br /> BATMTUB REFRIGERATICN UNITS— H.P.EA. <br /> LAVATORY�WASH BASIN) BOILERS — H.P.EA. <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINN d DISP. FORCEO A�R SVSTEMS— B.T.U. M EA. <br /> DISMWASHER WALL MEATERS— B.T.U. M <br /> LAUNDRY 7RAY UNIT MEATERS— B.T.U. M <br /> CLOTMES WASHER EVAPORnTIVE COOLEPS <br /> WATER HEATER C�O7MES�RYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE Ii00D <br /> FLOOR DRAIN AIP HANDLING:1NIT— C.F.M. <br /> VACUUM BREAKERS STOVE —WO00 <br /> ROOF DRAINS— aAINLEADERS METAL FIREPLACE 8 LHIMNEY <br /> SINK�SEFVICE — BAR,ETGI FIREPLACEINSERT <br /> HEAi PUMP <br /> SUB TOTAL 3 SUB TOTAL f � SO <br /> PEHMI7 f PERMIT ! 10 00 <br /> TOTALFEE S TOTAL FEE S 1� 50 <br /> SIOE YAFD SETBACK STREE7SE78ACK REAR VARD SETBACK PLAN CY.ECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUIITION FEE <br /> YES . NO <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNI75 <br /> BUILDING s <br /> SIZE OF BIDG. NO.OF STORIES MA%.OCC.LOAD <br /> PLUMBING <br /> FINE ZONE BASEMENT REOUSRED KLERS MECHANICAL 17 SO <br /> VES .NO <br /> APPROVALS BY DATE OTHER <br /> 1. ENVIRONMENTAL CHECK LIST PENALTY U.B.C. <br /> SEC.JO]1a) <br /> 2.BUIL�ING PLANS TOTAL 17 SO <br /> �,FIRE HVOPRNT <br /> 4.FIHE PRO7ECTION SVSTEM PERMIT VAIIDATION N <br /> WMEN PROPERLY VALIDATED IIN THIS SPACFI iMIS�S(�YOU'R/ PERMI7 <br /> S.GRADING q q �� (� ` I1 I I. ) O �-i <br /> 6.DRAINAGE ' r1 <br /> 7.ENVIPONMENTALIMPACTSTATEMENT C.O <br /> 8.HEALTH DISTRICT , . � �� <br /> APPLICATION ACC.BY PLANS CHECNED BY APPR.FOR ISSUANCE BY �. . .. C L I i- � <br /> , , .; � �_-. � I <br /> M.M. <br /> / i !_.i ,. � <br /> AODRESS FILE <br />