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a�.��s...� <br />CITV OF <br />everett <br />259-8745 <br />('�NSTRUCTION - .� <br />PERMIT PERMIT NQ: _ 16863 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL L�J PLUMBING ❑ SIGN <br />p�q M�ILADDRE55 CITV 21P PMON'_ <br />Our Savior Lutheran Church 215 W MuY.ilteo Blvd Everett, WA 98203 252-0413 <br />•PGHITECiONOE5IGNER MAILAODPESS CITY Z�P iMONE <br />GENENALCONTR�CTOR MAllAU0RE55 GTV ZIP PMONE LICENSEt <br />MECM�NICAL CONTR�CTON M�IL PDDRESS CITY 21P PMONE LICENSE � <br />PLUMBING CONTR�CTOR MFIL AUDRESS CITY ZIP PNONE IICENSE: <br />* Sateren Plumbina 5901 - 180 SW Lynnwood, WA 98037 743-3306 SATERP285� <br />C1A550F WORN <br />❑ NEW ❑ ADDITION � ALTEpATION ❑ NEPAIR ❑ DEMOLITION ❑ BI)ILDING RELOCATION <br />VALU�TIWI OF WORK <br />{ <br />DESCRIBE N'�RN <br />Install new sink in kitchen area <br />� ELECTRICITY ❑ GAS O WOODSTOVE ❑ OSHER <br />Church <br />lOT _ BLOCK � <br />215 W. Mukilteo Blve <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILETi <br />BATNTUB <br />LAVATORY (WASN 6ASIN� <br />SHOWER <br />NITCHEN SINK h OISP. <br />DISHWASHER <br />LAUNORYTNAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />PACKF�OW PREVENTERS <br />ROOF DHAINS - RAINLEADERS <br />SINK (SERVICE - BAR, ETC.) <br />Of LONST <br />SUBTOTAL <br />TOTALFEE <br />NO.OF STORIES <br />FIRE SPPINKIERS REOUIRED ❑ VES ❑ NO <br />APPLICRiIONACC 13Y <br />M.N. <br />COPIES) <br />I HFiiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />P.?PLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WI�L 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 />SIGNrItUBE OF CO�NTRACTOR � �t110—qIZ[D AGENT, OP OWNER DATE <br />X �7�%i.�,/oi��/�".-�s��% 7/22/86 <br />FEE I NO. <br />A/C - A/HNDLG UNITS - M.P. <br />REFRIGERATION UNITS - H P. I <br />BOILERS — BSUIht P. <br />GAS FIRED A.C. UNITS— B.T.U. <br />FORCED AIR SYSiEMS — B T.U. <br />WALL HEATERS — B.T.U. <br />UNIT HEATERS — 8 T.U. <br />EVAPORATIVECOOLERS <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERHEATEfi • <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />E%H�USTFAN <br />f 5 �� <br />f 10 0 <br />f 15 � <br />9DE SETencK pLAN CHECK tlUMI <br />VACANT SITE FEES <br />❑YES ❑NO <br />NOOFOWELLINGUNITS BUILDING <br />PLUMBING <br />MA% OCC. LOnD <br />MECHANICAL <br />SUBTOTAL <br />PEHMIT <br />TOTALFEE <br />FEE <br />INVESTIGATIONFLE <br />STATE BUILDING SURCHARG <br />STA7EENERGYSURCHARGE <br />: RIVEWAY PERMIT <br />Fee <br />M EA <br />M <br />M <br />�— <br />_ �� <br />�' 111'� 1' • <br />1i/ ::� - <br />y ;,����. 11 <br />TOTAL � � <br />PERMIT VALIUATION <br />WNEN PROPERLY VALIOATED pN THIS SPACE� iH15IS YOUR PEFMIT <br />i�l'1� ;655 f IL"t <br />M <br />C.� <br />� <br />CO <br />� <br />