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the EverRreen <br />�iTV OF <br />everett <br />CITV HALL 259A7�5 <br />EVERETT. WM 98201 <br />'i �JNSTRUCTION� � <br />PERMIT PERMIT NO. 14SHI. <br />❑ COMBINATION C# BUILDIN(i ❑ MECHANICAL ❑ PLUMBINO <br />OWNER M�IL AO�RESS CITY ZIP PMONE <br />DR. AND t�ffl5, BRUCE MAZN 1010 N PARK DR '�aFrr wa aA o- �52naip <br />ARGMRECT OP DESIGNER MAIL ADORE55 CITY 21 -�- - PMaNE <br />GENERAL CONTRACTOR MAIL �DDflE55 LITY 21P PNONE IICENSE I <br />HAROLDSEN CONSTRUCTION 813 N 29th RRNTON WA 98056 ��t—Sa�n <br />MECHANIC�L CONiRACTOR MAIL ADDRE55 QTY 21P PMONE LICENSE � <br />HAROLC247N <br />PWMBING CONTNACTOR MFIL ADDRESS CITY 21P PHONE UCENSE I <br />V~y� V V �EW ❑ ADDITION O ALTERATION ❑ REPAIR O DEMOLITION O FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSEHT <br />VALUATION OF WORK <br />f <br />lOT 46 BLOGN_OF <br />PLUMBIN6 <br />NO. TYPE OF FI%TURE <br />WATER CLOSET (TOILEn <br />BATHTUD <br />LAVATORYIWASHBASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISMWASHEF <br />LAUNDFYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUJM BREAKERS <br />ROOF DRA�NS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />PEHMIT <br />TOTAL FEE <br />IEET SETBACK <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />J. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />S.GRADING <br />8. DFAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEALTH DISTFiICT <br />APPLICATION ACC. BY PLANS CHE <br />stg jef <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />COFRECT. 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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />OR AJjfH(�iIZED AGENT DATE <br />FEE NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT f1EAfERS — B.T.U. M <br />EVAPORATIVE COOLEPS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />� <br />S <br />S <br />REAR YARD SETE <br />VACANT SITE <br />I.YES .�.NO <br />NO. OF DWELLIN <br />MA%.00G LOAD <br />FIRE S°RINKLFR: <br />REUUIfiED <br />VES I NO <br />FOR <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL f <br />PENMIT S <br />TOTALFEE S <br />FEE I (iECEIPT NO. <br />FEES I VALUATION � FEE <br />BUILDING S ],000.00 <br />PLUMBING <br />MECHANICAL <br />O7HEq <br />PENALTY <br />TOTAL I I 17 �50 <br />PENMIT VALIOATION <br />WHEN PROPEPLY VAUDATED pN THIS SPACE) TNIS IS YOUFjPERMIT <br />� � _ —� <br />� <br />�' <br />,, _-ri <br />�� � <br />i <br />ADDRESS FILE <br />U <br />