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rh.e E�•e.green <br />CITY O� <br />everett <br />CITV HALL 259�8745 <br />EVERETT, WA9B201 <br />'� �ONSTRUCT1011` � <br />PERMIT aeRnnir No. 16563 <br />❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNEH MAIIADDRE55 CRY 21P PNONE <br />Margaret Borden 2417 Virginia Everett, WA 98201 252-7503 <br />ARCNITECT OR DESIGNER MAIL ADDRE55 CITY 21P PMONE <br />GENERAL CONiRRGiOR MAiL qDDRE55 GTY Z P PNONE LIGENSE � <br />Damage Repair Service P.O. Box 2045 Everett, WA 98203/� 337-4222 DAMAGI238D3 <br />MEGMRNICRL CONTRRCTOR MAIL ADOPE55 CITY ZIP PHONE UCENSE � <br />PLUMBING CONiPRf,iOR MAIL ApDRESS CrtY ZIP PMONE LICENSE � <br />O NEW O ADDITION ❑ ALTERATION � REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN � WOOD STOVEIFIREPLACE INSERT <br />VAIURTION OF NORK <br />S 11�000. <br />Repair fire damaqe - sheetrock, front door, renew front steps, floor covering, painting <br />Residence <br />LOT <br />BELO'rY <br />PLUMBING <br />BATMTUB <br />SHOWER <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />WATER MEAiER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK ISERVICE — BAF, ETC.� <br />SUBTOTAL <br />PEflMIT <br />TOTAL FEE <br />NO. OF STORIES <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE IIYDRANT <br />a. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMcNT <br />9.MEALTM DISTflICT <br />APPLICATION ACC. BY PLANS CHECKED B <br />FOUN COPIE51 <br />I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APPLICATION 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 />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PCRFORMANCE OF CONSTRUCTION. <br />SIGNATUREOFWNTRAGTOROFAUTHpjVIZED4GEYT r'\ OATE <br />FEE N0. TYPE OF E�UIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIREO A.C. UNITS — TONNAGE EA. <br />FOflCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHESUHYERS <br />VENTILATION FAN <br />RANGEMOOD <br />AIR MANDLING UNIT — C.F.M. <br />� <br />S <br />S <br />REAR YARD SETF <br />VACANT SITE <br />YES NO <br />NO. OF DWELLIN <br />MAX.00C.LOAO <br />DAB <br />JIVVC — WVUU <br />METAL FIREPLACE 8 CMIMNEY <br />FIREPLACEINSEflT <br />SUB TO7AL f <br />PERMIT f <br />TOTAL FEE f <br />FEE I RECEIPT NO. <br />FEES I �A�UATION I FEE <br />BUILDING � b 11�QQQ � 8( �SQ <br />PLUMBI'!G <br />MECHANICAL <br />OTHER <br />PENALTV <br />TOTAL a8 5 <br />PENMIT VALIDATION <br />WHEN PROPERLV VALIDAT�O (IN iHIS SPACE) TMIS IS YOUR PERMIT —('r} <br />� ��-'2 ,' �I�b.J�U ii.7 <br />LC� <br />� <br />1 <br />BY . I <br />, ,. � <br />�DDR[SS FILE <br />� <br />