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dwCITY OF <br />— ('INSTRUCTION - nc <br />everett PERMIT PERMIT NO. 18954 <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 91MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Carl and Izzie Spotz 4802 Ocean Ave. Everett 98203 348-4407 <br />ARCHITECT OR DESIGNL9 MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE. LICENSE X <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />Winer <br />PLUMBING CON. <br />MAIL <br />CITY ZIP <br />I ICENSE F <br />CLASS OF WORK <br />NEW ❑ ADDITION E3 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />f 1400.00 <br />DESCRIBE WORK <br />Put in N7tB8MIN woodstove <br />HEAT SOURCE <br />rI ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Single family resiuence <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TriUE .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 CONSIRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE RACTOR.AUTHO• AG ,OHO%MER d DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR AT TACH FOUR COPIES) <br />2 5 Shore Acres <br />LOT _ BLOCK _ OF__ <br />JOB ADDRESS <br />11111W Ocean 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. UIH P <br />SHOWER <br />GAS FIRED A C UNITS — B T.U. <br />KITCHEN SINK f DISP <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — B T U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — BTU. 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 />_ <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />30 <br />99 <br />SINK (SERVICE —BAR, ETC) <br />METAL FIREPLACES CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL <br />S <br />SUB TOTAL <br />30 <br />OO <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTALFEE <br />30 100 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />[I <br />VACANT SITE <br />YES ❑ 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 />30 <br />00 <br />FIRE SPRINKLERS REQUIRED DYES CINO <br />INVESTIGATION FEE <br />Sec. 304(e) <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />S.H. <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />PERMIT VALIDATION <br />_ <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PEHMI I d- <br />tx) <br />Cn <br />ADDRESS FILE <br />