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theEbffgmm <br />CITY OF rONSTRUCTION <br />everett PERMIT PERMIT NO. 17434 <br />259-8745 <br />❑ DEMOLITION <br />Cl COMBINATION ❑ BUILDING <br />(R MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />Leenders, Richard <br />& Charlene 2027 Rainier Ave. <br />Everett <br />98201 353-3144/347-4291 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />CITY ZIP PHONE <br />Everett Fire Place Shop 5612 Evergreen Way Everett 98203 353-3722 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />Install wood stove <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOOOSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Single farily residence <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 A <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 CON TRUCTION. <br />SIGNATURE FCG TRACTOR. THORI AGENT R OWNER DATEinier f7 <br />X <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK _ OF <br />JOB ADDRESS <br />e <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC — AIHNDLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B T U /H P. <br />SHOWER <br />GAS FIREC ABC. UNITS — B T U. <br />KITCHEN SINK A DISP. <br />FORCED AiR SYSTEMS — Et, <br />DISHWASHER <br />WALL HEATERS —B T. U. EMI <br />LAUNDRY TRAY <br />UNIT HEATERS — B T.U. <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLFADERS <br />1 <br />WOOD STOVE <br />30 <br />Qo <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />sl <br />PERMIT <br />TOTALFEE <br />$I <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑No <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />3 <br />DU <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />INVESTIGATION FEE <br />Sec. 304(c) <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />DRIVEWAY PERMIT <br />TOTAL <br />30 <br />00 <br />APPLICATION ACC BY <br />PLANS CHECKED By <br />APPR FOR ISSUANCE BY <br />PERMIT VALIDATION <br />WHEN PROPER) V , ALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />L` <br />l� <br />Al)i)RE' : r 1, <br />