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A <br />the Evergreen MENEM <br />evereCITY OF tt r "ONSTRUC710N <br />PERMIT PERMIT NO. 12506 <br />r CITY HALL 2598746 _ <br />EVERETT, WA 98201 COMBINATION ❑ BUILDING LY. MECHANICAL ❑PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />SCOTT RAPiSAY _ 2402 MUKILTEO BLVD 98203 347-5487 <br />ARCHITECT ON DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOP <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE) <br />r <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE II <br />Same <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE F <br />L <br />GI NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />S <br />PROPOSED USE OF BUILDING <br />Residence <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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON CTOR OR AUTHORIZED AGENT DATE <br />X 10/4/83 <br />MECH CA <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT_SLOCK_OF <br />- <br />_ <br />JOB ADDRESS <br />2412 htukilteo Blvd <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N <br />TYPE EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />— <br />AIR CONH.P. EA. <br />D. S <br />BATHTUB <br />IGERl.TION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — M.P. EA. <br />SHOWER <br />KITCHEN SINKS DISP. <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 />DISHWASHER <br />LAUNDRYTRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE d CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />1 <br />Wood stove <br />7 <br />SO <br />SUB TOTAL <br />SUB TOTAL IS <br />PERMIT f <br />PERMIT f <br />1 <br />TOTAL FEE f <br />TOTAL FEE f <br />17 <br />50 <br />SIZE OF BLDG. NO. OF <br />FIRE ZONE BASEMI <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />L 2. BUILDING PLANS <br />3. FIRE HYDRANT <br />a. FIRE PROTECTION SYSTEM <br />6. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATE <br />FEE RECEIPT NO. <br />VACANT SITE <br />,.YES [.NO FEES VALUATION I FEE <br />7m <br />FOR ISSUANCE.Y <br />BUILDING <br />f <br />PLUMBING <br />MECHANICAL <br />17 <br />50 <br />OTHER <br />PENALTY <br />U.B.C. <br />SEC. 000 (a) <br />TOTAL <br />17 <br />5 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS Sr,P'Ci THIS f dTjP� VT�� j <br />77U-) <br />N <br />YOUR RECEIPT-4 <br />THANK YOU <br />- !! OCT 8 3 <br />L ADDRESS FILE _ <br />J <br />