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d�e £rer�reen <br />a, � c� <br />everett <br />GTV MALL 259�8745 <br />� � ' �ONSTRUCTlOP�" '"� <br />PERMIT PERMIT NO. � 5199 <br />EVERE7T,WA9820: � COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUM[iING <br />OWNER MOIL AD�RESS GITY ZiP PMONE <br />Dennis V. Diedrich 5512 lst Street Everett 98203 252-6339 <br />ARCHItECT OR OESiGNER MAIL AWRE55 CiiV ZiP PNONE <br />GENEHRL CONTRAGTOR MOII ADDNESS GITY ZIP PHONE LICENSE � <br />Same <br />M[CMFNiCAL CONTPAGTOR MAIL qODRE55 CITY ZIP PMONE LICENSE I <br />PLUMBING CONTRACTOR MRIL ADDRE55 CITY ZIP PMONE UCENSE 1 <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ RLPAIR EiCDEMOLITION ❑ FENCE ❑ SIGN O WCOD STOVFJFIREPLACE INSERT <br />OF WORK <br />3 <br />Demolish existing roof <br />Single Family Residence <br />S�S 3-N � 4 31 <br />LOT _ �LOCK _OF <br />SHOW BELOW OR PTTPGH <br />Town of Lowell <br />JOO AppRES,"i <br />5512 South lst nvenue <br />PI.UMBINO <br />SIDE <br />TYPE OF FIXTURE OR ITEM <br />V�ATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN� <br />SMOWER <br />KITCHEN SiNK 8 DISP. <br />DISHWASHEH <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />�RINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK �SERVICE — BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />TOTAI FEE <br />E ILOT AREA <br />FIRE ZONE <br />S <br />f <br />S <br />YES AO <br />OCGUPANCVGROUP NO.OF�WEI <br />NO. OF STORIES MA%. OCG LC <br />BASEMENT FIRE SPRINKI <br />APPROVALS <br />L ENVIROI. 7ENTAL CHECK LI57 <br />2. BUILDING PLANS <br />3. FIRE MYDRANT <br />a. FIPE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVI RON M cNTAL IMPACT STAT <br />B.HEALTM DISTRIJT <br />APPLICATION ACC. DY <br />PLANS CHECKED 9Y <br />BY <br />I HERE9Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPIICATION 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 />PERti11T DOES NOT PRESUME TO GIVE AUTHOfiITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OFCONSTRUCTION. <br />SIGN�11 EOFCONTRAGiONOR � OR12E�AG`ENT OATE <br />X 1 � /�lAA.P� %�Z3�BS <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />AIR COND. UNITS — M.P. F.A. <br />REFRIGERATION UNITS — M.P. EA. <br />801LERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M11 EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEAiERS — B.T.U. M <br />EVAPORATIVE COOlERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR 4ANDLING UNIT — QF.M. <br />STOVE — W00� <br />METAL FIREPLACE d CHIMNEY <br />FiREPLACEINSERT <br />IMEATPUMP _ <br />SliB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FEE I RECEI�T NO. <br />FEES I �A�UATION I FEE <br />BUILDING I$ OO I OOI OO <br />PLUMBING <br />MECHANICAL <br />OTIIER <br />PENALTY I SECV303 <br />TOTAL I I 00I �p <br />PERMIT VALIDATION <br />N'HEN PROPERLY VALIDATEO (IN THIS SPACE) iHIS IS YOUR PERM�T. ._- � <br />� <br />c-'� <br />� <br />� <--{ <br />ADDR[SS fILE <br />