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, <br /> - CP'`I5TRtJ�TION �� <br /> � � PERMIT APPLICATION � � <br /> COMBINATION • BUILDING • MECHANICAL • PLUMBING <br /> ONNkR MAIL 11ODNEYS ZIY PHUNE <br /> David A. Brandvold P.O. Box 3066, Everett, WA 98203 355-1135 <br /> ARCHITECT OH DE514NER MAtL AOONESS MONE LICENSE NU. <br /> OENERAL CONTRACTOR MAIL ADORESS /MONE LICENSE NU. <br /> Same as Owner BR AN DD A2990K <br /> MECNANICAL CONTqAGTOR MAII AODRE55 • /HONE UCENSE NO_ ' <br /> Evergreen State Sheetmetal . <br /> ►IUMtlING CONTRACTOR MAIL ADDRESS ►HONE LICENSE NO. <br /> Ray's Plwnbing <br /> ��ENMIT CIASSOf WORK • --� " I <br /> ❑COMBINATION I <br /> �BUILDINC �PLUMBIN6 i]MECHANICAL � <br /> �NEW ❑ADUITIUN ❑ALTEfINIIUN ❑NCI'MR <br /> VALUATIO OF WORK —` �"'-'-" ""—' <br /> S �OOO ❑OEMOLISM ❑FENCE ❑SIGN ❑SWIMMIN(i PUOL <br /> DESCFIBE WORK <br /> Construct single family residence � <br /> . �ROYOSED USE OTHER PERMITS OR APPROVAlS � <br /> � Single family residence ,� REZONE � SPECIAL USE � <br /> � Lf6AL U65CHIPTION OF PROPENTY ISMOW BELOW OR ATTACN � <br /> . FOUR COPIE51 <br /> � �ou1J{LSCe�ocKt?.�.os Attached ,yT F #VARIANCE � SF'ORLINE <br /> ' SEPA CHECK LIST REQUIREO � <br /> �': !/� i� �'U<S/O�r� '� T•� LI' YES <br /> L� NO ' � <br /> G--,- l�- zQ-•�' <br /> � <br /> � �oa�ooness ; <br /> Pine Street at lOth / o/ 3 ��NE ST� MECNANICAI � <br /> .� PLUMBING . TrvE os cNenar <br /> ❑�+AS ❑ELEC. � <br /> � ��j . N0. TYPE OF EOUIPMENT � FEE � <br /> �_.._—__ <br /> AIRCOND.VNITS-H.P. E0. S I <br /> , ' a NO. TVPE OF FIXTUNE OR ITEM FEE qEF�r+icERATioN uN�rs i�.v. En T_ -�— � <br /> - flA1H TI1tlS S ' -' OOIlERS N.P. EA. ' """'-""-'—�" � k <br /> " CLOTHES WASHER - � - � --1---�-- r <br /> FORCED AIR 5►STEMS-B.T.U. MEA. � <br /> - ' DISNWASMERS — .•-- --_.._. _.__ __i <br /> ' DR�NKING FUUNTAINS � _ � . __ ._ __ __. __ <br /> ., �+ � FI.00R DRAINS � SIACE 8 WAIL HEATERS �- A.T.U. T—_ � <br /> 4 � - -- • t <br /> •,r„ , ��,- KITCHEN tiINKS 6 DIS . UN�i ��EATERS e.r.V. 1 ' <br /> , ,,�. BAHSINKS � EVAPOFATIVECOOLEHS -��y��- <br /> . �. .:'� NOOF DRAIN5 RAIN IEAUERS ' --""----" ' �� Fy� � <br /> �. _ 1 CLOTHES DRVEHS <br /> ?•`..,j; SHOWERBATHS VENTILATtONFAN -�T�� ! <br /> � ' �� � � "• SEHVICE SINKS � � P <br /> '� " �� ' ' RANGEHOOD A1� <br /> �' . -�i: - : � SUMPS - SEWAGE PUMP 1 �- -"' —�T� Y <br /> U�INALS _ A�R HANDLINf:UNIT C.f.M. _ 1 , <br /> � '�� � WATER ClOSETS _ ' _'...-... . . . : � _ . ' ' .,. _T—_ � <br /> WATER NEATEItS - ELECTRIC M/1TEN NEATER _ ._ __L_�� <br /> WASH BASINS FAC BUILT FIREPLACE M1 CNIMNEY � <br /> - LAUND V TRAVS 6A5. SYSTEM: NO OP OU7L1:15 � �Ti��� ; <br /> . . � ' �- — --'--- . ...sun ic�rn� 5 �T <br /> 1 — '—"._"_ PERMIT .—S "_".^. � <br /> � � "'-- '— ' TOrAI FEE S _�� <br /> � � SUB TOTAL 11115 PEfIMIT OECOMES NUI L ANO VOIU 11 WU11K OR CONSTAUG <br /> ' PERMIT S 110N AUTIIURI'LED IS NOT COMMLNC[O WITNIN 1?0 UAYS, Oq IF <br /> � E CUNSTRUC�ION OR WORK I:i SUtiP1:NUE0 OIl A[IANDONEO FOp A ' <br /> kN'7ER SERVICE SIIE BLOG.SUPPLV SI2E PERIOD OF 170 OAVS AT ANv tIM! AF TEN WOf1K I.^.CO��RtENCEU. � I <br /> FhAHYApOSETBAC - � ���RE[iY CERTIFv TNAT 1 IIAyE REAU AND C%4MINID f1115 AP� � <br /> �� ��Q �UCATIpN ANO KNOW THE SAME TO Ok THUE NND COIIHECi.ALL : <br /> . � � ^ F ��� OF WOHK WI�L BE COMPL11EDrWIT/1 WHETNERESPECIFIEUiHERE1N <br /> � �tIJE YONt ~ WT ANLA 1%ACANT SR! 011 NOT, TNF GRAN:ING OF A PERMIT Dp[S N07 PRESUME TO '. <br /> � 2 61VE AUTIIORITV TO VIOIAfE OR CANCEL T11E PRUV151nN3 OF <br /> jjj C�t`S ❑NO , ANV 07HER STATE OR LOGI LAW HEGUl4TiN4 CONtiTHUCTION <br /> � TV/E O MST. OCCU/ANCY RROUP uN;Os DWELLING ��'THE�ERFORMANCE Of CONSTHUCTION, , <br /> �nl le- 3 / <br /> , � 612 Of BIDG. NO. �STORIES MA%.00 . LOAU �� ,f/ � L, <br /> l� �I��N� IIA�!'���Ik�@ T INLSYHINKLLII'ti SIGN UREOfCO TRA RAUTII.AGIiNT p TE / <br /> ��� � . / REOUiHfU �/ �qN N K UMBER P�ANCHkCKtE! <br /> � /l/ ❑YES l]NO -�7� <br /> , .L �� it[ RECEIP7 Nt�. <br /> " S►kC1AL CONOITIONS: <br /> � , .�...���..._ .... .. _ ._ .. ... _ . ..... �._.. . <br /> -r�, FEES VALUATION FEE <br /> '�' _._�.___� .+__T <br /> �*-' -'----- - <br /> ---_- � eui�oiNa �j��V _���f�0 <br /> SEPA REVIEWCOMPLETE ' ❑YES ❑ NO ' ��UMIIINIi --_M.• /7r1 in <br /> 'vCJt V <br /> -' i <br /> confocf p�onn�nq dapf. Mtc�i�Hic�� • p.� <br /> . _ �-S�.... <br /> OTNER � � <br /> 1 <br /> i nonµctri.u�r. ruwoncuow: �weuwo o�ir. �ENALTY SEC.00]IH 1 <br /> � " -.-� _ -"_'-'--_ '._.. _/7-�--.�_.L�_. <br /> ---.- '_ ...-- � --'. -� G ,_-_� — TOTAL "!/VL/ �ClV <br /> f <br />