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the <br />EILwWz <br />OF C "INSTRUCTION <br />ev -8745 PERMIT PERMITNQ:=21 25 <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION EJBUILOING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Richard Fortman 2114 Rainier Everett, <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRAC. OR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />Damage Repair Service <br />Box 2045 Everett, WA <br />98203 <br />337-4222 DAMAGI283D3 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />❑ NEW ❑ ADDITION ❑ ALTERATION C5kREPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />:$20,000 <br />Repair fire gutted upstairs <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. 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 CONSTRUCTION. <br />SIGNATU L'T q THORIZED AGENT. OR DWNE PATE <br />X f <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES <br />LOT _ BLOCK _ OF <br />JOB ADDRESS <br />2114 Rainier Ave <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 />A,C — A,HNDLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - B.T.U./H R <br />SHOWER <br />GAS FIRED A C UNITS — B.T.0 <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS —BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T U. M <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 — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT f <br />PEFMIT <br />TOTALFEE <br />f <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VAC :NT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ 20,000 <br />207 <br />00 <br />PLUMBING <br />10/26/88 12:45PM <br />0OW153 <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />#0�T0��0.21125 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />BLM. 304(e) $2C <br />7.00 <br />STATE BUILDING SURCHARGE <br />CHECH $21 <br />.50 3 <br />50 <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />M.M. <br />PLANSCHECKEDBY <br />APPR FOR ISSUANCE <br />BY <br />DRIVEWAY PERMIT <br />_ <br />TOTAL <br />210 <br />50 <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />i <br />ADDRESS FILE <br />