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' �� <br />r <br />� <br />L <br />CITY O� <br />everett <br />CIiY HALL 259�87d5 <br />EVEPETT, lNA 98201 <br />� <br />�ONSTRUCTIOP' <br />PERMIT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />PERMIT N0. 12492 <br />� PLUMBING <br />OWNER h1A1L ADORE55 CIiT 21P PHONE <br />KAY �1. SC'NRIIDFR 2431 T1(1NRf1P AVP FVFRFTT qR9p3 3S�-1 n�n <br />ARCMITECT ON DESIGNER MAIL AD�RE55 GIiY LIP pqONE <br />GENERAL CONTRACTOR MAIL AOORESS CITY 21P PHONE LICENSE 1 <br />__�me <br />ME�:MANILAL CONTRqGTOR MAI� AODRESS dTY 21P PHONE UCENSE M <br />PLUMBING CONTRqCTOR MFIL AD�RESS CITY ZIP PHONE LICENSE � <br />❑ NEW � ADOITION �.,.�J ALTERATION O REPAIR ❑ �EMOLITION ❑ FENCE ❑ SIGN O WOOD STOVE/FIREPLACE INSERT <br />A <br />VALUATION OF WORK <br />S <br />l01 _ BLOLN _OF _. <br />JOBAOORE55 <br />Z43. <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />WATEF CLOSET (TOILEn <br />BATHTUB <br />SHOWER <br />KITCNEN SINK 8 DISP. <br />DISHWASMER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOGR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK �SERVICE — BAR, ETC.) <br />SUB TO7AL <br />PERMIT <br />70TAL FEE <br />APPROVALS <br />t. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDHANT <br />4. FIRE PROTEC710N SVS7EM <br />5. GRADING <br />6.ORAINAGE <br />7.ENVIRONMENTALIMPACTS7ATEMENT <br />8. HEALTH OISTRICT <br />i <br />S <br />S <br />YARD <br />FEE <br />YES . NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISION£ 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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGP�T� OF CONTRqCTOR 0 FUiMOR2ED �PGEN1 // DATE <br />x /!(�, ��� �}L�: t/I/!� �/R,���!� <br />FEE <br />AIR COND. UNITS — H.P. EA. <br />FEFRIGERATION UNIiS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — 70NNAGE EA. <br />FORCED AIR SYSTEMS — B.7.U. M EA. <br />WAIL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. �1 <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILAIION FAN <br />RANGEHOOD <br />AIR HANOLING UNIT — C.F.M. <br />STOVE — 1N00D <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL f <br />PEHMIT S <br />TOTAL FEE S <br />FEE I RECEIP7 NO. <br />FEES � VALUATION I FEE <br />BUILDING <br />1AX. OCC. LOAD <br />PLUMBING <br />IRE SPRINKLERS MECHANICAI <br />EOUIRED <br />YES NO - <br />BY DATE O7HER <br />PENALTY <br />TOTAL <br />�PUCATION ACC. BY PLANS CHECKED BY I APPR. P� � <br />5 <br />U.O.G. <br />SEC. 303 <br />0 11 <br />PERMIT VALIDATION <br />WHEN PROPERL� VALIDATED (IN THIS S2 �CC) THIS � xO�I�PF�it�IT— (�y <br />[ � f! U U U U U <br />��. <br />BY i��.:�u�; FGC[IPT�� � <br />i � 4�.I ji ' � U <br />� I�I/z�.:.� � <br />ADDRESS FII.E <br />.� � �EP b ) <br />� <br />JI <br />� <br />