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u� �,�g,�„ <br />CITY OF <br />everett <br />259-8745 <br />��"` P`�NSTRUCTION � <br />PF.�tMIT <br />� <br />PERIIAIT NQ: _ � U � `� 5 <br />❑ DEMOLITION � COMBINATION ❑ BU OING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRE55 CItY :IP PMONE <br />DOUGLAS R. LIBBY 6101 OAKES EVERETT WA 98203 355-5201 <br />ARCNItECTORDE5IGNFR MNLnpCRE55 CITY ZIP PHONE <br />MAII qDORE55 <br />CITY 21P PMONE LICENSE r <br />Same <br />MECMANICRLCONTMCTOR MRILA�ORE55 CITY 21P PMONE UCENSE� <br />PLUMBINGCONTRAGTOR MAILADORE55 CITY ZIP PHONE LICENSE� <br />CLASS Oi WORK <br />❑ NEW lj�l ADDITION ❑ ALTERATION ❑ REPAIR 0 DEMOLI'f10N ❑ BUILDING RELOCATION <br />VAWNTION OF WORK <br />$ <br />DESCRIBE WORN <br />Plumbing, mechanical <br />❑ ELECTRICITY ❑ GAS <br />'ROPOSED USE OF BUILOING <br />Single family residence <br />LOT _ BLOCN _ <br />JOB ADDRE55 <br />6101 Oakes <br />PLUMBING <br />N.7. TYPE OF FI7(TURE OR ITEM <br />WATER CLOSET �TOILET � <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRVTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />BACKFIOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINN (SERVICE — BAR. ETCJ <br />TYPE OV <br />Si2E G!' �LDG. <br />naruCnrioNncc or <br />SUB TOT11L <br />PERMIT <br />TOTALFEE <br />REAR 5[TBACN <br />LOT AREA <br />OCCUPAHLYGROUP <br />p�aNs c�+ecneo or <br />❑ WOODSTCVE ❑ OTHER <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIOtJS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER S"ECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT �OES 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 CONSTP.'1CTION. <br />SIGNATU�EOFCONT�R1ACtOR.RUTH.O�.R,/2EDAGENT.OROWNER DAtE <br />X C1��r��./f__ /� .s� _ /t/'A. . <br />FEE NO. TYPEOFEOUIPMENT <br />A/C — A/HNDLG UNIT$ — HP. <br />REFRIGERATION UNITS — HP. EA. <br />BOILERS — 8 T.0 /H.P. <br />GAS FIRED A�G UNITS — � T.0 <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALLHEATERS—BTU. M <br />UNIT HEATERS — BSL. M <br />EVAPORATWECOOLERS <br />j CLOTHESDRYERS <br />� VENTILATION FAN <br />RANGEHOOD <br />WATER MEATER • <br />WOODSTOVE <br />METAL FIREPLACE & CMIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXMAUSTFAN <br />S <br />f <br />S <br />Vr1CANT SIiE <br />❑VES ❑NO <br />NO OF DWELLING UNITS <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />INVESTIGATION FEE <br />STATE OUILDWG SURCHARG <br />STATE ENERGY SUfiCHARGE <br />DRIVEWAV PERMIT <br />S <br />; I;i 1 . b?�7 <br />�� <br />TOTAL I I <br />PERMIT VALIDATION <br />\VHEN PROPERL\' VALIDATED �W THIS SPACE� THIS IS VOUR PLRMIT <br />�� o�;F;s r�� � <br />