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die Errrcrrc�i <br />�.;, �. <br />everett <br />CITY HALL 259�8745 <br />�� �ONSTRUCTION� � <br />PERM�� PERMIT N0. 15309 <br />EVERETT,WA98201 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �] PLUMBING <br />OWVER MAILAO�RESS CIiY 21P PHONE <br />Lois L. Stevenson 5617 Rockefeller 96?03 353-6566 <br />ANCHITEGT OR OES'�GNEF MAII ADDRESS qTV Z�P PMONE <br />GENERAL CONTRAGTOR b�AIL FDORESS GITY 21P PNOIiE LILENSE � <br />ME[MANICAL GONTRACTOR MAIL F��RESS GTV ZIP PMGNE LICENSE N <br />PLUAIBING GONTRAGTOF MAII ADDRESS CITY 21P PHONE LILENSE M <br />Same <br />❑ NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION <br />f <br />install <br />on <br />LOT _ BLOCH _OI <br />5617 Rockefeller <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />WATER HEATER <br />URINAI <br />Oh71NKING FOUN7AIN <br />FIOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, E7C.) <br />SUB TOTAL <br />70TAL FEE <br />SIZE OF BLDG. NO. OF <br />FIRE ZONE BASEM <br />APPROVALS <br />1.ENVIRONMENTALCHECK LIST <br />2. 6UILDING PLANS <br />3. FINE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DfiAINAGE <br />7.ENVIRONMENTALIMPACTS7AT <br />6. HEALTH DISTRIC7 <br />APPLICAl10N ACC.BY PLAI <br />�S <br />REAR YARD S <br />VAGANT SITE <br />VES .NO <br />N0. OF DWEL <br />MA%. OCQ L( <br />FIRE SPRINKI <br />PEOUIFED <br />VES . NO <br />a T- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND K.NOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVtSIONS 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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CO;JSTRUCTION OR THE <br />PERFORMANCEOFCONSTRUCTION. <br />cif,l:4TlHnF OF CONTRACTOR qA AUTHORIZED AGENT DATE <br />N0. TYPE OF EOUIPMENT <br />AIR GOND. UNITS — H.R cA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES ORYERS <br />VEN7ILATION FAN <br />FANGENOOD <br />A:R HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEA7 PUMP _ <br />SUB TOTAL S <br />PEHMIT 5 <br />TOTAL FEE S <br />',NUMBER PLAN C <br />FEE <br />FEES VALUATION <br />BUILDING <br />PLUM8ING <br />MECHANICAL <br />OTHER <br />S <br />FEE <br />RECEIPL NO. <br />FEE <br />� 1� <br />PENALTY SEC 303 (a) __ <br />��Tp� 5 00 <br />PERMIT VALIDATION �� ^ <br />WMEN PROPERLY VALIDA7ED pN THIS SPACE) THIS IS YOUR PEFMIT—�— �' <br />0 <br />M <br />� <br />� <br />FORISSUANCE BY � <br />ADDRES.`, FlL[ <br />