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`�� r' C'�NSTRUCTION - <br />everett P�RMIT PERMITNO. � J�6O <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEfl h1AiL�0�RE55 GITY 21P PMONE <br />Dean Moulton 3723�Rockefeller Everett, WA 98201 252-0972 <br />ARCMiTECT OR OESIGNFF MAIL RODRE55 dTY ZiP PNONE <br />GENERALCONiPACtOR MRILADDRE55 CITY ZIP PHONE LICENSE� <br />Owner <br />MECHPNICPL CONTPACtOR MAIL ADORE55 CITY ZIP PNONE UCENSE • <br />PWMBINGCONTRACTOP MAILADDRE55 CITY Z�P <br />CL/.$$ OF WORN <br />❑ NEW ❑ ADDITION � ALTEHATION $7 REPAIR ❑ DEMOLITION <br />VRLURTION OF WORK <br />Sli���. <br />OESCRiBE WORK <br />Reroof, siding, replace any studs that are bad to make walls straight <br />HEATSOURCE <br />❑ ELECTRICITY O GAS ❑ WOODSTOVE ❑ OTHER <br />garage <br />21 6 22 922 <br />LOT _ B�OCK _ <br />�tl MUU� YJJ <br />31�2 It4ckefeller <br />Friday's lst Addition <br />PLUMBING <br />NO. TYPE OF FI7(TURE OR ITEM <br />WATEF CLOSET �TOILI <br />BATMTUB <br />LAVATORV�WASHBA; <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />LAUNORVTRAV <br />URINAL <br />DRINKING FOUNTAIN <br />FLCOR DHAIN <br />BACKFLOW PFEVENTERS <br />HOOF ORAINS - RpINLEA0ER5 <br />SINK �SERVICE - �AR, ETC.� <br />SUBTOTAL <br />PEflMiT <br />TOTRLFEE <br />REARSEIBACN <br />LOT PREF <br />TVPE OF CONST <br />SIZE OF i1lDC <br />M.M. <br />FEE <br />5 <br />f <br />5 <br />s�oE se*oncK <br />VAGANT SITE <br />❑ YES ❑ NO <br />UP NO OF DWELLING UNITS <br />MA% OCC LOI.D <br />O <br />DV APPR FOR ISSU/ NCE DY <br />LICENSE i <br />O BUILDING RELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ ANi) EXAMINED THIS <br />APPLlCATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WhETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE FROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SiGNATUR OFCONTRARGR.AUtMONZE/ry AG[NT.OROWNER �AT[ <br />X �.t� �t�/i./� 12�28�8% <br />MECHANICAL <br />NO. TYPE Oc EOUIPMENT FEE <br />A/C - A/HNDLG 11NITS - H P. <br />REFRIGEflATION UNITS -HP. EA. <br />BOILERS -- BS.0 /H.P. <br />GA$ FIRED A�C. UNITS - B.TL. <br />FORCED AIR SYSTEMS - B T.U. M EA. <br />WALLHEATERS-B.T.U. M <br />UNIT HEATERS - 0 T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DfiYEflS <br />VENTILAiION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL PIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEnTPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PENMIT <br />TOTALFEE <br />FEES <br />NO. <br />FEE <br />BUILUING S 1�U00. 25 <br />PWMBING <br />MECHANICAL <br />INVESTIGATION PEE Sec. 304(e) <br />STATE BUILDING SURCHARGE , <br />STATEENERGVSURCHARGE - <br />DRIVEWAY PERMIT �� <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPER' V VALIDATED (IN THIS SPACE) TMIS IS VOUR PERMIT <br />;,;t:)I';ESS i ILE <br />3 <br />m <br />