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(lie P"CInITTYOF <br />r ONSTRUCTION <br />everett <br />PERMIT <br />PERMIT NO. <br />_ 23752 <br />259-8810 <br />❑ DEMOLITION <br />i7 COMBINATION ❑ BUILDING <br />❑ MECHANICAL ❑ PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />William & Gayle <br />Bluhm 10910 3rd Dr. SE <br />Everett, <br />98208 <br />348-6093 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE# <br />Owner <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />0 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO IF OTHER THAN ABOVE <br />CONTRACT PRICE OF WORK: $ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Woodstove <br />PROPOSED USE OF BUILDING <br />SFR <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIESI <br />LOT _ BLOCK - OF <br />JOB ADDRESS <br />TnGTn I'A M, RR <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EBUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC - A/HNDLG UNITS - H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS - B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS - B T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR. ETC) <br />SUBTOTAL S <br />SUPEBTOTAL f <br />30 <br />00 <br />PERMIT S <br />PERMIT <br />RMIT $ <br />- <br />- <br />EE $ <br />TOTALIFFRONT <br />TOBiIIA�/9D 4e25FY1 <br />OOOAN9550o <br />40 <br />SETBACK <br />REAR SETBACK SIDE <br />SETBACK <br />PLAN CHECK NUMBER <br />FEE / <br />N00023752 <br />RECEIPT NO. <br />USEZONE <br />LOT AREA VACANT <br />SITE <br />❑ YES ❑ NO <br />FEES <br />LDINGCOD <br />FEE <br />BUILDING <br />- <br />$ <br />TYPE OFCOKSTRUCRONALLBNABLE <br />TYPE OF CONSTRUCRON ACTUAL <br />'p` <br />NO OF BWFLLING UNIT$ <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />30 <br />00 <br />OCCUPANCY LOAD FIRE SPRINKLERS RED-D "EIGHT LIMITATION <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />L <br />LOCAL SALES <br />TAX CODE IS <br />3105 <br />PUBLIC WORKS <br />TOTAL <br />30 <br />00 <br />wNFN aanaFRLY vAuoATED <br />THIS IS <br />YOUR PERMIT <br />Q <br />PERMITS EXPIRE IF WORK IS NOT COMMENTED WITHIN ADDRESS FILE 23759 <br />180 DAYS OR CEASES FOR MORE THAN 180 DAYS. <br />