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r1ieei�KY°F �--' '�ONSTRUCTIOIV�� � <br />everett PERMIT PERMIT NO. 1223$ <br />CITY HALI 259�B7d5 <br />EVERETT, WR 98201 � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAILApDRE55 GITY ZIP PNONE <br />DON ROGERS 4511 SEAHURST EVERETT WA 98203 252-4701 <br />/RLMITELTOROESIGNER MAILADOPE55 GTY ZIP PMONE <br />GENERnL GONTRACTOR MAIL ApDRE55 CITY iIP PMONE UCENSE � <br />Owner <br />MECHANICF� CONTR4CTOR MAIL ADDRESS CITY ZIP PHONE LICENSE � <br />PLUMBING :ANTRFGTOR MRIL ADORE55 CITY IIP PMONE LICENSE � <br />❑ NEW O ADDI710N ❑ ALTERATION el�REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD S70VE/FIREPLACE INSERT <br />f �5��.�� <br />ir work <br />Rental - residential <br />�or 18 BLOGN_OF Maple Hel <br />1022 Mukilteo Blvd <br />PLUMBING <br />TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />SHOWER <br />DISMWASHER <br />LAUNDRYTRAV <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />VNCUUM BREAKERS <br />ROOF QRAINS — RAINLEADERS <br />SINK (SE� VICE — BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />TO7ALfEE <br />EET SETBACK <br />TYPE OF CONST. <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS � <br />3.FIREHI'DRANT �_ <br />4. FIRE PROTEC7ICN SYS7Fd► <br />S.GRADING ; � � <br />-TrENVIRONMENb9LIMPAGL6TATEMENT <br />HEALTHt1i6TRICT � <br />APPLICATIOR f,C . IfY LANS CHE <br />00 �/ 11 O <br />�,,, � . , o <br />m <br />-i <br />c� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />Fouawriesi CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />#2 GOVERNING THIS TYPE OF WORK WIIL 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 />SIGYl. REOF�y TRACTOROR4UTMOPREDAGENT DAiE <br />X t m,w „eo. c._. 7/21 /83 <br />FEE <br />+ L <br />S <br />S C <br />REAR YARD SET[ <br />VACANT SITE <br />:--.VES . NO <br />NO. OF DWELLIN <br />MA%.00C.IOAD <br />FIRE SPRINKLER: <br />REOUIRED <br />YES , NO <br />MECHANICAL <br />AIR COND. UNITS — M.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FOPCED AIR SYSTEMS — O.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATER$ — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR MANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 6 CMIMNEY <br />FIREPLACEINSEHT <br />NEAT PUMP <br />SUB 70TAL f <br />PERMIi 3 <br />TO7AL FEE S <br />C NUM6EF PLAN CI <br />FEE <br />FEES VALUATION <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTMER <br />PENALTV <br />TOTAL <br />�1500.00 <br />FEE <br />RECEIPT NO. <br />FEE <br />25 <br />2 <br />2% <br />WHEN PROPERLY VALIOATED (IN THI59 ��� THIS ��04�R�FEBh�T ��(yy <br />U/� V ��j <br />N <br />N <br />R. FOR ISSUANCE BY Y� U R R � C E I PT•-+ <br />�NC TIIANK YOU <br />I+CDRE55 FILE <br />`11�83 <br />� <br />� <br />H '~*1 <br />N � <br />� <br />O <br />� <br />N <br />� S <br />H H <br />� y <br />� � <br />� N <br />� <br />. � <br />� <br />x <br />H <br />N <br />H <br />M <br />