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.PPLICATION FOL'the <br />eYrreR <br />E"I'VIVII <br />CONSTRUCTION <br />DE <br />CITY OF CITY <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRIN <br />259-BB 10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />O PLUMBING <br />❑ SIGN <br />OWNL" <br />Vay.id Whi.teseCC <br />MAII Al1URi.55 CITY ZIP <br />4825 (Vest View DA.ive Ev¢nett 98203 <br />MIONE <br />252-1084 <br />PNONC <br />An6ntLPT OR DLSOONER <br />MML ADDRESS CI IY )IP <br />NIA <br />)Ip <br />PHONE <br />LICENSE <br />OFNEnAI CONIRAOIOn MAIL ^PDRE31 <br />4th PL. <br />S E Lvchett. 98208 <br />743-1925 <br />MRBUIWC142JJ <br />MR. BUILD WtiCC.ia"IS C=61- 8929 <br />CITY lipMIONE <br />.ICE NSC <br />NFCIUHIF.0. CONIRAC,tOR MML ADDRE95 <br />MAIL ADDRESS <br />Pl UMSINR C0N1nACf on <br />CIIY ]II` <br />Lunnluood 98037 <br />PHONE <br />743 9559 <br />I ICF 115C• <br />KURF�IG237 LT <br />Ace Sewn 6 DA(Un 16907-20th West <br />EI.AS nr won. <br />❑ ALTERATION ® REPAIR <br />❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION— <br />❑ NEW ❑ ADDITION <br />vu u.noN or wOnK (COST o• MAlcnws ru15 LAnnul <br />3,517.00 <br />DT SCRIBE WORK <br />RepaiA dAV notlhemove tub, instatt new, <br />add toindoty, heptace zhee.thoC <br />LOI_BLOCK_- <br />4825 West V.ielu AVI)c <br />PLUMBING <br />NO, TYPE OF FIXTU <br />WATER CLOSET ITOILETI <br />1 BATHTUB <br />LAVATORY (WASH pA51N1 <br />SHOWER <br />KITCHEN SINK A OISE <br />DISHWASHER <br />LAUNDRY TRAY <br />f1 OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />EveaeLt. wa. 98203 <br />ROOF DRAINS — RAINLEADE <br />_ ',SERVICE— (SERVICE — pnR. ETC I <br />1BUNT SETBAb <br />SIZE OF <br />ACC <br />I HEREBY CERTIFY THAT 114AVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Or CONTOACTOR ORAUTIIORIZED AGENT DATE <br />.rry ICAH TB bl Y BUSINESS 11CF 115E HO <br />MECHANICAL <br />ITEM FEE NO. TYPE OF EQUIPMENT <br />MC — A114NDLG UNITS — H P <br />RErRIGEPATION UNITS —IIP EA <br />DOILERS — EIT U ,H P <br />GAS FIRED AC UNITS — BTU <br />FORCED AIR SYSTEMS —B T U M EA <br />WALL HEATERS — BTU. M <br />UNIT HEATERS — B T U M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION PAN <br />RANGE HOOD <br />-- -- WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE A CHILINEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />SUBTOTAL <br />14AN CHECK NUMBER (FEE <br />VACANT SITE <br />FEES <br />OYES ONO <br />BUILDING <br />$ <br />No or DMILLINO <br />PLUMBING <br />MAX OCC LOAD <br />MECHANICAL <br />-- <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />ArPR ron ISSUANCE By <br />PUBLIC WORKS <br />TOTAL <br />LEEE I <br />RECEIPT NO. <br />FEE <br />PROPERTY LIWNERS ARE RESPONSIBLE DETERMINING ALL <br />PROPERTY LINE LOCATIONS ANDRELATED EASEMENTS. <br />