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dir !: rer�mrr� <br />� ,,, �: <br />everett <br />CITV MALL 259�8745 <br />EVERETT,VlA 98201 <br />� ''ONSTRUCTION <br />PERMIT <br />❑ COMBINATION ❑ BUILDING XX MECHANICAL <br />PERMIT NO. 1L��jy% <br />❑ PLUMBING <br />01VNEF IdAtL A�DRESS QTY ZIP PnONE <br />G D SEAVY 329 ROCKEFELLER FVERETT WA 98201 254-8770 <br />ARCMIiELT OR OESIGNER MAIL AODPE55 LItY ZIP PHONE <br />G[NE(iALGONTRACTOR MAIL AODCESS GITY ZIP PNONE LICENSE • <br />MECMANICAL GONTRACTON MAIL qDORESS GTY ZIP PMONE LICENSE � <br />Same <br />PLUMBING GONTRACTOR MAIL ADORE55 CRV 21P PHONE LICENSE • <br />❑ NE\N O ADDIrION O AL7ERATION ❑ REPAIR ❑ DEMOLITION O FENCE ❑ SIGN $s WOOO STOVE FIREPLACE INSERT <br />VAWAiION OF IYORN <br />S <br />11 fireplace insert <br />LOi_BLOCK_OF <br />JOB <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />WA7ER CLOSET (TOILEn <br />BATHTUB <br />SHOWER <br />KITCHEN SINK d DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />UflINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINK (SERVICE - BAR, ETC.) <br />SUB TO7AL <br />PERMIT <br />70TAL FEE <br />USE <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILOING PLANS <br />3. FIRE HVDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. �RAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT _ <br />B.HEALTH DISTflICT <br />APPLICATION ACC. BV PLANS C MECKED BV <br />I HENFBY CERTIFY THAT I HAVE READ A�.D EXAMINED THIS <br />APFLI�ATION AND KNOW THE SAME TO BE TRUE AND <br />coviesi CORRECT. ALL PROVISIONS OF LANS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.'i HE GRANTING OF A <br />PERMIT DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAVJ REGULATING CONSTRUCTION OR THE <br />PERFORMANC OF CONS UCTION. <br />siw+nrun�oSC�Nt ACTO�ORAU OR12EOAGENi DATE <br />x / ,,� z 4/11/85 <br />.� �� «�_,��� <br />FEE <br />S � <br />REAR YARD SETBACK <br />VES NO <br />REOUIRED <br />VES NO <br />AY I OATE <br />MECHANICAL <br />NO. TYPE OF EOUIPMEN'f" <br />AIR COND. UNITS - N.P. EA. <br />REFqiGERATION UNITS - H.P. EA. <br />BOILERS - H.P. EA. <br />GAS FIRED A.C. UNITS - TONNAGE EA. <br />FORCED AIR SVSTEMS - B.T.U. Id EA. <br />W'ALL HEATERS - B.T.U. M <br />UNIT MEATtRS - B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VEN7ILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT - C.F.M. <br />STOVE - WOO� <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />PLAN <br />BUIIDING <br />PLUMBING <br />MECHANICAI. <br />OTNEfl <br />PENALTV <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />PLAN CI <br />FEE <br />VALUATION <br />IS <br />SEC.3U3 <br />FEE <br />RECEIPT NO. <br />FEE <br />TOTAL I I 17 I 50 <br />PERMI7 VALIDATION <br />WHEN F'ROPERLY VALIDATED �IN THIS SPACE) TH�S IS YOUR-AERMIT j'�,� <br />i �; <br />(rl <br />C <br />i �'� <br />:DDRF�G � ����- <br />z <br />O <br />� <br />n <br />m <br />--I T <br />fn 2 <br />0 <br />m <br />co <br />m o <br />n <br />--I C <br />O 3 <br />m <br />—i Z <br />2 —I <br />m <br />.O � <br />C <br />a —+ <br />r x <br />.. .-i <br />--I tn <br />< <br />T <br />O .'o <br />T Y <br />� m <br />2 <br />m� <br />N <br />0 <br />o r <br />�m <br />C V1 <br />� N <br />zn <br />--i r <br />• m <br />a <br />a <br />� <br />x <br />a <br />z <br />� <br />._-� <br />N <br />2 <br />O <br />-i <br />.. <br />n <br />m <br />