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�M� <br />> �-3 <br />,0�15 <br />C x� <br />H a3' <br />y Z r-+ <br />K H 7nJ <br />o xo <br />� C�/1 r�; <br />H t" <br />xz3 <br />� o r� <br />HC <br />O H <br />�/��g <br />y� V C] <br />9H� <br />r z <br />r-+ y <br />g�' <br />H <br />C] C7 C� <br />� e� r <br />ZH� <br />H O fn <br />! � ! <br />! 1= <br />lhrErrrArri�n �r.�ySTRUCTiON � <br />��„ ��� - <br />everett PERMIT PERMiTNo. `'`'y`+`' <br />259-8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />:.a[n �.+ail ac[�nE55 <br />crtv ziv ;��oue <br />�Rk Iiobert G. Clark PO Box 573 L•veret[, IdA 98206 259-H8�0 0272 <br />7� � ; HT \IAII ADOR[55 <br />CiTY ZiP �r10N[ <br />rd:,^Hii EGT OR �ESIG:IER Ma�L ADDRE55 <br />CITV ZIP FIIONE <br />i,( tiL��L CONiAFCTOR MAIL A��RE55 <br />CITY ZIP PHONE LICENSE � <br />Self <br />C11Y Z�p PHONE LIGENSE• <br />AtEGMANICAL CONTRAGTOR MA�L / O�RESS <br />Self <br />��rv 2ip vr�anE ucers[= <br />_ _._ __..__.,,�,,.. MRILAD�PE55 <br />ci.+ss or wenK <br />❑ NEW <br />i7d eoomoN ❑ ALTEHATION 9 NEPAIH ❑ DEMOLITION ❑ BUILDING RELOCATtON <br />CONTRACT PRICE OF WORK: S SOO. <br />C[SC�IpE \50RN ANO SOUA��E fOOiAGE INVOLYI <br />:lechanical for '�-emodel <br />coNtnCrrEnsor�nruDFnor+erv� i� �� ��,• �,.-�•^�• <br />��ncroseo usc or nwioc+u <br />Single family reeidence - <br />lEG0.L �ESCmai�oN of CnOVE�av �5r�0e/�ELON 0�� niTnCH �o�•�� Co�iES <br />�Or— oiocn— a�- <br />Joonoonrs�.; <br />2116 hICDu'Igall <br />PLUMBING <br />NO. TYPEOF <br />WATERCLOSETIT' <br />LAVATORY <br />SINK d DISP <br />GLOTHES <br />OiiINKING FOUNTAIN <br />FLOOR DRAIN <br />D�CNFLOW PR[VENTE <br />ROOF DRAINS -- RAWI <br />SINK �SEFVICE - OAR. <br />USE lOrvE <br />oro�oc <br />fOfl <br />Pt.H. <br />MECHANICAL <br />�TEM FEE NO. TYPC OF EOUIPi <br />AC �����:�LGUNITS-NP <br />FU�C[D.�IR S�STEMS - �7 T U <br />UNIT HEATERS - B T U. <br />CLpTHESDAYERS <br />2 VENTILAiION FAN <br />— RANGEMOOD <br />1 1•fATER fiE�1EH <br />wOODSTOVE <br />ME1AL FIREPLACE 8 CHI6WEY <br />FIREPLACEINSER� <br />HEA7 PUMP <br />GAS PIPING <br />EXNAUSTfAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />{ I:[AI�`.C11��.1CN <br />�utnn[n <br />uoaaumwnu rvna[oNsteucnau+nui <br />NO Of STOPIES <br />)AO fIf1E50pINNlERS�[OD <br />❑ YES ❑ NO <br />�'IM1NK�CR$ <br />ncc av r�nNs.,�•vr,ov[ou, <br />f <br />� <br />Srt)E Sf 111nC8 <br />PLAN CHECK <br />SUBi01'AL <br />PERMIT <br />TOTAL FEE <br />VACNNt SITC FEES �- <br />❑ VE$ ❑ NO 5 <br />�„�� � Hooroxnu•+GCa�s BUILOING <br />PLUMOING <br />[t�SEMENT <br />❑ YES � NO ti�FCHANICAL <br />��OGrt u�.nTnno�� OiHEfi <br />STATE OUIIDING SURCHARGE <br />tiTATEENERGYSURCHARGE <br />CITY OF EVERETT PU�LIC WORKS <br />LOCAL SALES <br />TAX CODE IS <br />3105 <br />PERMITS EXPIRE IF WORK IS NOT COMMENf:ED WITHIN <br />180 DAYS OR CEAS[S FOR MORE THAN 180 DAYS. <br />� <br />�Ui)NESS fI�L <br />h7 GA <br />!.t <br />FEE <br />� <br />5 <br />S <br />PECEIPT NO <br />IS IS <br />:1J <br />Z55�4� <br />00 <br />