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r�� <br />c��v oF <br />everett <br />259-8745 <br />� �ONSTRUCTIOIr � � /� <br />PERMIT PERMITPIQ:;��`�O� <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING p$I MECHANICAL ❑ PLUMBING ❑ SIGN <br />OMMER MR�LRODNESS CITY ZIP PHONE <br />CURTI�, W. HAUGEN 3b23 Rockefeller Everett WA 98201 252-7108 <br />ARCHITECT OR DESIGNLR MAIL /DDRESS dTY ZIP PHONE <br />GENERALCONTRACTOR MAILADDPE55 CITY 21P PNONE LICENSE� <br />Craft Stive <br />MECNANICALCONTRRQOR MMLAODPE55 pTY ZIP PMONE IICENSE� <br />C�A55 OF WORK <br />❑ NEW ❑ ADOITION <br />VALURTION OF WOPR <br />$ <br />AIAIL ADDRE55 <br />❑ ALTEHATION <br />CITY ZiP PNONE LIGENSE � <br />❑ REPAIR ❑ DEMOLITION ❑ BUILDING REIOCATION <br />Install wood stove <br />MEATSOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />SED USE OF BUlll <br />Residence <br />LOT � � a I�OCN ytyl._ <br />3623 Rockefeller <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />W�..ER CLOSET �TOILET) <br />BATHTUO <br />LAVATORV (1YASH BASIN� <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOfl ORAIN <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR. ETCJ <br />SUBTOTAL <br />PEflM1T <br />TOTAL FEE <br />USE <br />OCCUPANCY GHOIIP <br />yw:.e <br />APPLIC/TION�CC OY <br />FEE <br />VRCANTSRE <br />❑VES ❑NO <br />NO OF DWELU <br />maz occ �ono <br />APP�i FORISSURNLEl�Y <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 LA'NS 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 <br />VIOLATE OR CANCE� THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNy�' E OF CCNTRACTOF A,�UTI)I JR 2ED AGENT. OR 01VNER �ATE <br />X(%�iy.tJ `�1��?'✓CcGC.�jt/n� 11/4/86 <br />MECHANICAL <br />NO. TYPE GF E�UIPMENT <br />A/C — AiHNOLG UNITS — M P. <br />REFRIGERATION UNITS — HP. EA. <br />�OILERS — BS.0 MP. <br />GnS FIRED A C. UNITS — B TL <br />FORCED AIR SVSTEIdS — B T.U. M EA. <br />WALLNEATERS—BS.0 M <br />UNIT HEATERS — BSL. <br />EVAPORATIVECOOLERS <br />CLOTMESORYERS � <br />VENTILATION FAN <br />RANGEHOOD L <br />WATER H[ATER • <br />� WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHECK NUMOER <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />INVES7IGATION fEE <br />SUBTOTAL <br />PEHMIT <br />TOTALFEE <br />FEE <br />VALUATION <br />S <br />Sec.304�e) <br />FEt <br />FEE <br />STATE 7UILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />DRIVEWAV PERMIT <br />TOTAL <br />PERMIT VAlIOATION <br />WHEN PROPERLV VALIDATED �IN THIS SPACE) THIS IS YOUR P[fiM1T <br />A' : NC;;S f l! E <br />� <br />