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theELwrvvm <br />CITY OF • <br />everett <br />259-8745 <br />&NSTRUCTION <br />PERMIT <br />PERMIT NO. <br />1677E <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANIr,AL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP P.-ONE <br />John W. Thompson 4632 So. 3rd Avenue Everett 98203 252-5754 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERA)CONTRACTOR <br />MAIL ADDRESS <br />CIT/ <br />ZIP <br />PHONE LICENSE. <br />Everett Bldrs. Inc. <br />5606 Evergreen Way <br />Everett <br />98203 <br />353-7161 <br />MECHANICAL CONTRACTOR <br />I.PE ADDRESS <br />CITY <br />$I <br />PHONE LICENSE. <br />EV-ER-EB-*3-11L3 <br />PWMBING CONTRACTOR <br />MAIL ADDRESS <br />I Rv <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION CF WORK <br />$ 4,367.00 <br />DESCRIBE WORK <br />Tear off and reroof and gutters <br />t IEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PPOPOSEO USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYFE 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 PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THEqPFORMANCE OF CONSTRUCTION. <br />SIGNOF CONTR R. AUTHORIZED AGENT. OR OWNER CAL;/, <br />X �j7 X <br />LEGAL DESCRIPTION OF P.OPERTY(SHOW BELOW OR ATTACH FOUR COP.ESI <br />LOT _ BLOCK _ OF 5001-004 _Qljj- 000 <br />Lowell Div A plat of ELK 004 D-00 All lots 15 & <br />16 refer to account NIIR for addr.d legal descrip. <br />JOB ADDRESS <br />4632 So. 3rd Avenue <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WA' PR CLOSET (TOILET I <br />A — A;HNDLG UNITS — H P <br />BATHTUB_ <br />REFRIGERATION UNITS — H.P EA <br />i AVAT29Y (WASI: BASIN) <br />BOILERS — B.T.0 M.P. <br />'HOWER <br />GAS FIRED AD. UNITS — B.T.0 <br />KITCHEN SINK A DISK <br />FORCED AIR SYSTEMS — B T.0 M EA <br />DISHWASHER <br />WALL HEATERS —BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T.U. M <br />CLOTHES WAS4ER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />WOOD STOVE <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE —BAR. ETC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL f <br />SUB TOTAL <br />PERMIT f <br />PERMIT <br />TOTALFEE f <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />OYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />Q .T�I12 <br />���lJ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMPING <br />SIZE OF BLDO. <br />NO. OF STONER <br />MAX.00C LOAD <br />MECHANICAL <br />BLDG $7 <br />00 <br />FIRESR.'VKLERSREOUIRED QYES QNO <br />INVESTIGATION FEE <br />8 5RQ604(e) $ <br />.50 <br />STATE BUILDING SURCHARGE <br />i <br />SO <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />AMR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />73 <br />50 <br />ecnwr NwI Ieennu <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />12�— <br />L` <br />Co <br />a-- <br />ADUPI:" I iL._ <br />