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A <br />fheEuc�7qrcen �-7NSTRUGTION �� � crI <br />everett PER��AIT PERMITNO. _ �UU4� <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING K] MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAtLA�DRESS C11V ZIP PMONE <br />Hills Collins 1502 :IcDougall Ave. Everett, S4A 252-9G90 <br />TENAN! MPILrIODRE$5 LITY ZIP PHONE <br />Owner <br />OR DESiGNEN <br />GENERAL <br />MA:� ADDPE55 <br />MAIL AOD41E55 <br />MECHANiCNL CONTRACTOR MRIL ADDB[55 <br />Valley P:at. Gas 2605 hlcDougall Ave. <br />PLUMBING CONTRqCTOR MAIL AODRF55 <br />CLRSS OF WORK <br />❑ NEW ❑ ADDITION 6YJ�LTERATION <br />CITY <br />QTY <br />Zp PMONE <br />21P PHONE LILENSE• <br />CiiY 2iF PHONE LICENSE• <br />Sverett, [dA 259-5492 VALLENG153L1 <br />C�TV Z�F VMONE L�L[NSe• <br />❑ REPAIR O DEMOLITION ❑ BUILDING RELOCATION <br />j CONtACT PERSON ANO VMONE NO IF O1N[R THnH ntlWE <br />CONTRACT PRICE OF WORK: S i e 3SS. OO I <br />�ESCRiBE WOFK AND SOUARE FOUTAGE INVOWED <br />Install furnace and AWH <br />PROPOSED USE OF OUIL�ING <br />SinQle Fam-ilv <br />LEGRL DESGPIPTION OF PROGENTV �SHOW BELOW OR ATTACH FOUR COVIESI <br />LOT - B! OCN - OF <br />JODADDfVESS ` �� $ <br />1502 PlcDougall Ave. � <br />PLUMBING MECHANICAL <br />NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EO FEE <br />WATER CLOSET (TOILEi) A/C -- A%HNDLG UNITS — H <br />BATHTUB FORCED AIR SYSTEMS — B. <br />LAVATORV IWASH BASINI UNIT HEATERS — BSL. (�� M <br />8 OISP. <br />LAUNDRVTRAV <br />CLOTHES WASHEF7 <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRE`/ENTERS <br />ROOF DRAINS— FAINLEADE <br />SINK ISERVICE — BAR. ETC.) <br />US[20NE <br />iYiT OF CONSiNL'!iION nLLOWAI <br />5¢[OFpLDG <br />OGCUPANCYLOAO <br />f.fA50N FOR SPqiNRL[t15 <br />SUBTOTAL f <br />PEPMIT S <br />TOTALFEE S <br />�iEP.f15[TD�CK SIOESETP�frc <br />LOTAREA <br />1VR OF CONSiPVC110N 0.L1Ual <br />NO OF STONiES <br />FIR[ SPRiNKLERS REO'0 <br />❑ VES ❑ NO <br />5V �PLANSAPPROVE��Y <br />CLOTHESDRVERS <br />VENTILATION FAN <br />fiANGE MOOD <br />1 WATERHEATER <br />WOODSTOV! <br />METAL FI(iEPLPCE 8 CN�MP <br />FIREPLACEIYSERT <br />MEATPUMP <br />2 GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />LHECKNUMBER FEE <br />vnc�Nr sire FEES <br />❑ VEE ❑ NO <br />— ;;^•p� xooFovrtwxcuN�is BUILDING S <br />PLUMBING <br />B�SEMENT <br />❑ SES ❑ NO MECHANICAL <br />HEIGHTUMITAiIQN nTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGVSUFCHARGE <br />CITY OF EVERETT <br />LOCAL SALES WUOLIC WORHS <br />TAX CODE IS TOTAL <br />3105 WHEN PROPERLY VALI <br />S <br />RECEIPT NO. <br />IS YOUR <br />FEE <br />PERMITS EXPIRE IF WORK IS NOT COMMENCED WITHIN r,uuRfss i ii r. � U O'4 �.. <br />180 DAYS OR CEASES FOR MORE THAN 180 DAYS. <br />