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Q <br />IhP EverArfPn � p N ST R U CT I O P• <br />CITY OF � <br />everett PERMIT PERMIT NO. 125gH <br />CITY HALL 259�B7d5 <br />EVERETT,WA9B201 � COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />p1YNER MAILADDRE55 Everett ZIP zse-i�'8gE <br />Prudence Stork 1705 Rninier <br />ARCMITEGI OR DESIGNEP MAIL RO�RE55 GITY ZIP PHONE <br />GENEPPL CONiRACiOP MAIL AOORE55 GITY 21P PMONE UCErvS[ � <br />Minor Home Repair Sr.nior Services 3402 112th S.W. Everett 98204 355-1112 <br />MEGHANICAL CONTR�GTOR MAIL AppRE55 CItY ZIP PHONE LICErvSE � <br />PLUMBINGCONTRRGTOR MAiLADORESS CRY 21P PHONE lIC@:SL� <br />❑ NEW ❑ NDOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑\YOOD STOVEIFIREPLACE INSERT <br />5 IS�. DO <br />Build ramp <br />lOT_BIOCK_OF <br />PLUMBING <br />NO. TYPE OF FIXTUHE OR ITEM <br />WATER CLOSET QOILEn <br />BATFITUB <br />LAVATORY�WASM BASIN) <br />SMOWER <br />KIiCNEI! SINK 8 �ISP. <br />DISMWASHER <br />LAUNDRViRAY <br />CLOTMESWASMEF <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR �RAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAI. <br />SINK �SERVICE — BA <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />t. ENVIRONMENTAL CMECK f.�ST <br />2. BUILOING PLANS <br />3. FIRE HYDPANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPFCT STAI <br />B.MEALTH DISTRICT <br />APPLICATION ACQ BY PLA <br />BY <br />I HERFBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND OFDINANCES <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 REGULATING CONSTRUCTION OR THE <br />pE A E OF CONSTRUCTION. <br />5 ATOR OF TPACTO /UJ�R7fiiZ�ENT / / OPiE <br />/ /� 10 21 83 <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILF.RS — H.P. EA. <br />GAS FIRED A.C. UNIiS — TONNAGE EA. <br />FOHCED AIR SYSTEMS — BSA. M E <br />WALI MEATERS — B T.U. M <br />UNIT HEATERS — B.T.U. M <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANOLING UNIT — <br />STOVE — W�00 <br />METAL FIREPLACE 8 CMIMNEV <br />FIRFPI.ACE INSERT <br />S <br />f <br />f <br />REAR YARO SETBACK PLAN CH <br />VACANT SITE <br />;IYES '.!NO <br />MA%. <br />RED <br />NO <br />eui�owc <br />PLUMBING <br />MECHANICAL <br />OTMER <br />PENALTY <br />TOTAL <br />C.F.M. <br />S118 TOTAL <br />PERMIT <br />TOTALFEE <br />FEE <br />YALUATIOI <br />s 150.00 <br />UBC. <br />SEC. 303 la) <br />� <br />f <br />S <br />�HECK FEE <br />RECEIPT NO. <br />FEE <br />10 00 <br />10 <br />renmii ...���,..�.,.. �3�'� �U�i U. U U <br />WMEN PROPEflLY VALIDATED (IN THI � TMI �L � <br />� <br />N <br />`';�'�' � R RcCEIPT r-1 <br />ISSUANCEBY ; �.: •,e�� <br />i,_ i.�,♦ I l.' U <br />ADDF:E55 f II E <br />'% � c�T S S <br />