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II <br />u <br />`,'�`,"`+."+„ CONSTRUCTICV <br />��TY oF � __ - <br />eveT�l.l. PERMIT PERMIT NO. 1Z4O� <br />CITY HALL 259�B7d5 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ 6UILDING � MECHANICAL ❑ PLUMBING <br />OWNER <br />MAIL ADORE55 CITY ZIP PHDNE <br />Roger Jimmestad 2121 Rainier Everett 98201 <br />ApCHI*ECT OR �ESIGNiR MAR A�DRE55 CITY 21P PMONE <br />GENERRLGONTRACTCR MRILApDRE55 CITY 21P PNONE UCENSEI <br />MECMANIGALCONTRPdTOR <br />MAIL A�OPE55 CITY ZIP PNONE IICENSE � <br />Natural Gas Equipment 1611 East Grand 98201p 258�H441 L��J�� <br />❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />S <br />ESCNIBE W�AK <br />RO�'OSE� USE OF �IIILOING <br />EGRL DESCRIPTION OF PROFERtY �SNOW BELOW OP RT7AGN FOUN COPIES� <br />LOT__tlIOCN__OF <br />lOB AODRE55 <br />2121 Rainier Avenue <br />PLUMBIN6 � <br />NO. TYPE OF FIXTURE OR ITEM FE <br />W ATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORY (WASM 9ASIN) <br />SHOWER <br />KITCMEN SINK 8 DISP. <br />DISHWASHER <br />LAUNORYTRAY <br />CIOTNES WASMER <br />WpTER HEATER <br />URINAL <br />ORINKING FOl1NTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEAOERS <br />SINK �SERVICE — BAR, ETC.) <br />SUB TOTAL f <br />PEHMIT s <br />TOTALFEE S <br />SIDE YARD SETBACK STREET SETBACK REAR YARU Si <br />USE?ONE LOT AflEA VAC/+NT SITE <br />,..YES .�NO <br />TYPE OF CONST. � OCCUPANCY GROUP NO.OF DWEL <br />OF <br />1. ENVIRONMENTAL CHECK UST <br />2 BUILfiVG PLANS <br />9. FIRE MYD'n.CNT <br />4. FIHE PROTECTION SVSTEM <br />S.GRAOING _ _ <br />7. ENVIRONMENTAL IMPACT <br />6. HEqLTM DISTFICT <br />APPLICATION ALC. BY <br />MA%. <br />FOR <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 �AWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PEFM IT DOES NOT PRESUME TO GIVE AUTHOfiITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />IOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. ) <br />���.....�aencrnumermaruv.uTHORIZED/GENT _ /�ATE`_ <br />MECHANICAL <br />AIR COND. UNITS — H.P. EA. <br />flEFRIGERATION UNITS — M.P. EA. <br />BOILERS — N.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIN SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.1.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES ORYERS <br />VENTILATION FAN __ <br />RANGEHOOD <br />AIR MANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE S LHIMNEY <br />FIR`PLACEINSERT <br />HEAT PUMP __ <br />PLAN GHEGK NUN <br />FEES <br />BUILDING <br />PLUMBING <br />MECMANICAL <br />OTI4cR <br />SUB TOTAL <br />PERMIT <br />rTOTALFEE <br />I FEE <br />5 <br />S Q <br />S <br />f 14 <br />CHECK FEE <br />RECEIPi NO. <br />VALUATION I FEE <br />14 <br />PENALTY SEC. 909 �a� <br />TOTAL l4 5 0 <br />PEflM1T VALIDATION a � 8 �� ��__ �_ <br />WHEN PROPERLY VALIDATED (IN TI�S��Ar•Ei THI I IT <br />t' ' <br />Y_,UR P,[CEIPT � ' <br />aY -�i;nNK YOU <br />AUDRF55 RLE <br />IZ��'83 <br />• <br />