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rne �,�r, <br />an oF <br />everett <br />259-8745 <br />" C� NSTRUCTION <br />PERMIT <br />r'�+, �°"`` <br />PERMITNQ: 20297 <br />❑ DEMOLITION ❑ COMBINATION 0 BUILDING ❑ MECHANICAL '� PLUMBING ❑ SIGN <br />��ER MqILADDRE55 CIiV <br />Bill 0'Brien 5037 33rd Ave. W. Everett 98203 353-4254P PNONE <br />RRCNITECT OR UESIGNER MqIL qpDRE55 LITY 21P PHONE <br />Michael D. Grote 1321 Hoyt Everett 98201 252-2976 <br />GENERALLONTPACTOfl MAILADDPESS CITY ZIP PNONE LICENSE� <br />Bill o'Brien <br />MECHANICAL CONTflAQOR MAIL pDp0ES5 CITY ZIP PHONE LICENSE • <br />PLUMBING CONTfUCTOR MAIL pD�RESS CITY ZIP PHONE 4LENSE � <br />GLFSS OF WOHN � - � <br />❑ NEW ❑ ADDITION ❑ ALTEpAT10N �REPAIH � DEMOLITION � BUILDING RELOCATION <br />VALUATION OF WORN <br />�rJ��00.0� <br />DESCRIBE WONK <br />Bldg. repair and relocation <br />MEATSOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />LOT 5�6 BLOCK le8 <br />PLUMBING <br />ZQ <br />OR ITEM <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORV �WASH BA: <br />SMOWER <br />KITCHEN SINK 8 OISP. <br />OISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PqEVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINK �SERVICE — BAR, ETC.) <br />R-2 <br />TYPE OF CO <br />V-N <br />SIZE OF 8L0 <br />I215 <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 q <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUqp,DF CONTRACTO . AUT RIZ�D AGENT. OR ONRlEN DATE <br />X � ��.fur.J �/,Zld...!/ � /%ti� <br />MECHANICAL , <br />FEE NO. TYpE OF EOUIPMENT <br />F/C — A/MNDLG UNITS — HP. <br />REFRIGEHATION UNITS — H.P. EA. <br />BOILERS — B.T.0 MP. <br />GAS FIPED A.G UNITS — 9. <br />FORCEDAIRSVSTEMS—B.T.U. EA. <br />WALL HEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER � <br />WOODS70VE <br />MC-TAL FIREPLACE 8 CHIMN <br />FIREPLACE INSEHT <br />HEFTPUMP <br />GAS PIPING <br />EXHAUSTFAN .._� <br />SUBTO7AL f <br />PENMIT f <br />TOTALFEE s <br />20 <br />LOTAREA <br />U2OO <br />OCCUPANGYGNOUP <br />R-3 <br />NO OF STONIES <br />mdati n 1 <br />iPEOUIRED ❑YES [�jNO <br />BY PLANSCNECNED �V <br />B.E. <br />5 <br />VACANT SITE <br />GIYES ❑NO <br />NO OF DWELLING UNITS <br />1 <br />MA% OCC l0/D <br />FOR <br />B.E. <br />SUB T � `�� � ', �_ <br />PEPM 6 �_ <br />TOTA �Q <br />PLANCMECKNUMBER F LOG sS (.�JIPTNO. <br />88/20297 gl�p 37�i39 <br />FEES '�LI�TION U.fX) FEI <br />BUILDING 5��: f$9 .� <br />PLUMBING <br />MECHANICAL <br />INVESTIGATION FEE $ec. Jpp�e) <br />STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />ORIVEWAV PERMIT <br />TOTAL <br />PERMIT VALIDATION <br />WMEN PROPERLY VALIDATED �IN THIS SPACE� THIS IS YOUR PERMIT <br />AGi���.�',S f i� E <br />FEE <br />i••�� <br />1851 5 <br />�• <br />Q� <br />N <br />O <br />N <br />