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L1e CnNSTRUCTION !- everett PERMIT PERMIT NO. 19958 <br />259-8745 <br />❑ DEMGI I1ION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Gary Alcumbrach 1911 Mukilteo Blvd. Everett, WA 98203 353-8636 <br />ARCHITECT OR CESIGNER MAIL ADDRESS CITY ZIP PHONE <br />ADDRESS CITY ZIP PHONE LICENSED <br />MECHANICAL CONTRAC TOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE? <br />Valley Natural Gas <br />11323 Highway 99 <br />Everett, WA 98204 <br />355-7730 <br />VALLENG153LI <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSED <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION Fa ALTERATION Cl REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />f <br />Install BOM BTU Furnace and water heater. <br />HEAT SOURCE <br />n VI FrTRIrITV ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Single family residence <br />LEGAL DESCRIPTION OF PROPERTY I —OW BELOW OR ATTACH FOUR COPIES) <br />LOT � BLOCK __ OF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE 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 CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU EOF CO TRA O /UT RIZED AGENT, OR OWNER DATE 'yI <br />X L / <br />JOB ADDRESS <br />1911 Mukilteo WRX Blvd. <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 — AMNDLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B T.UH P. <br />SHOWER <br />GAS FIRED AC UNITS —BT. U. <br />KITCHEN SINK S DISP. <br />1 <br />FORCED AIR SYSTEMS — S T.0 M EA <br />9 <br />00 <br />DISHWASHER <br />WALL HEATERS — B T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAR4 <br />RANGEHOOD <br />BACKFLOW PREVENTERS <br />1 <br />WATER HEATER <br />6 <br />S <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUR TOTAL <br />S <br />50 <br />PERMIT <br />f <br />PERMIT <br />S <br />00 <br />TOTALFEE <br />f <br />TOTALFEE <br />In <br />So <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />ygOgNT SITE <br />DYES ❑No <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <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 />5 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <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 />30 <br />50 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED JIN THIS SPAUt) I <br />L17 <br />Q) <br />ADDRESS FILE <br />