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0 <br />„ <br />ihr[re.cmCn ;. � �ON:+TR�ICTIOf'' <br />everett PERMIT PERMIi' NO. 12976 <br />CITY HALL 259-B7a5 <br />evEnen.wner ,i � COMBINATION ❑ BUILOING �,�1 WIECHANICAL ❑ PLUMBING <br />OWN[R '.14iLADDRE55 CrtY ZiP PMONE <br />KARF.N PF.TF.tLSON 4 FVFRFTT 98203 ZSZ—Ei�B <br />FRCHRECT OR DESIGNEP MnIL RODRE55 CIiV ZiP PMONE <br />GENERnL CJNiRAGiOP MAIL ADDRES$ GTV ZiP PHONE UCENSE � <br />S MrEFCMRNICAL CONTRRGTOR MAR ApORE55 GITY 21P PNONE LIGENSE • <br />PWMBING GONTRPCTOR MPIL RD�RES$ GITV ZIP VMONE LiCENSE � <br />� NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ DEMOLITIO�: ❑ FENCE ❑ SIGN O WOOD STOVE'FIHEPLACE INSEFT <br />VALUATION <br />S <br />�oT _ o�ocn _oF <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />W ATER CLOSET (TOILEn <br />BATHTUB <br />SNOWER <br />KITCMEN SINK 8 DISP <br />DISITYJASHER <br />LAUNOHYTRAY <br />CLOTMES WASMER <br />V�ATER HEATER <br />URINAL <br />DRINNING FOUNIAIN <br />FLOOR DRAIN <br />VACUUM �REAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINK ISERVICE - BAR, ETC.� <br />TOTAL FEE <br />APPROVALS <br />1. [NVIPONMENTnL CI'ECK 115T <br />.^. BUILDING PLANS <br />J. FIflE MYORANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DflAINAGE <br />7. ENVIRON MENTAL IMPACT STATEMENT <br />8. N iALiM DISTRICT <br />APFUCATION ACC.BY PLANS CHECKED <br />LC <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEL� THIS <br />APPLICATION ANO 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.1 �1E GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOC.4L �_AW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE CF CONSTRUCTION. <br />SIGNATUP� OF CONiRAf,�ON OJi AUTNORiZED AGENT �A�E <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. 6A. <br />REFRIGERAiION UNITS — M.P. EA. <br />801LER5 — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIfl SYSTEMS — B.7.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE GOOLERS <br />CLOTHES DFYERS <br />VENTILATION FAN <br />RANGEMOOD <br />AIR MANDLIYG UNIT — QF.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEATPUMP _ <br />i <br />f <br />f <br />REAR YARD SETOACK PLAN CHEGN NUMBER <br />VACANT SITF FEES <br />vE5 NO <br />NO. OF DWELLING UNITS <br />BUILDING <br />MA%.00C.LOAD — <br />PLUMBING <br />FIRE SPRINKLERS MECNANICAL <br />REOUIREO <br />YES NO <br />BY DATE aTMER <br />PENALTY <br />FOR �GSIIANCF <br />LC <br />SUB TOTAL S <br />PERMIT f <br />TOTALFEE S <br />PLAN C <br />FEE <br />S <br />i�a <br />flECEIPT NO. <br />VALUATION I FEE <br />U.B.C. <br />SEC. 30J <br />TOiAL I I 1� ��Q <br />PERMIT VALIDATION <br />WHEN PROPERLV VALIDATED (IN THISSRPGE� TH� �`�O�R �E�MIT (� <br />/ t 7 1 � � d <br />�7 <br />C� <br />�� � �� R RcCFIPT � � <br />� , �'v,����� 1 l)�� <br />?DDRFSE FILE <br />-9FEB 84 <br />� <br />