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(AP£YCI�TYCUF Cr�NSTRUCTION - � �" <br />everett PERMIT pERM111T NO.O�9�A <br />CITY HALL 259�8745 <br />EVERETi, WF 9020' ❑ COMBINATION � BUILDING ❑ MECHANICAI ❑ PLUM9ING <br />OWNEP ��AILAUORE55 C11V ZIC f110NE <br />Tohn T C`harhnnaa❑ ➢517 W lnyyt Euerett aR��7, �o-na�T�_ <br />RPC�iIiECiORD[514NCli MAILAD�RE55 GiY ZIP PNONE <br />(h:TIPT' <br />GENERFI CANiRFCiOfV MA�L AGDPE55 p1Y 214' PMON[ IICENSE � <br />�LTMPI^ <br />M[CHnNiLALCANiRACTOR MARAD�RE55 GTY ZIP PHUIL UCENSEI <br />PLl1MBINGCANiRACiOR 61AllADDRE55 C11V 21P PHONE UCENSEI <br />__.__ _. .. __ . <br />❑NEW ❑AODITION ❑ALTERATION C}�REPAIP LiDEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUAi10N OF WORR <br />} 120�.00 <br />DESCFIUE WORK <br />Asphalt shingles <br />PR01'OSE� USE OF BUILDINO <br />Residence <br />ior�],�ioc�_oF <br />JOB AODRE55 <br />251 <br />PLUMBIN6 <br />CLOTHES WASHER <br />WATER MEATER <br />URINAL <br />DRINKING FOUNTf <br />FLOOR DRAIN <br />VACUUM BREAKER <br />ROOF DPAINS — F <br />SINK ISERVICE — I <br />OF BLDG. <br />FIRE <br />B[LON'OR ATTACN <br />OF FIXTURE OR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO� <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW FEGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNRLIIRE OF CqNLRACiOP OR AUiNO��ZEp AGENT DRTE <br />TYPE OF EOUIPMENT <br />AIRCOND UNIiS—HP.EA. <br />REFRIGERATION UNIT$ — H.P. EA <br />60RER5 — H P. EA <br />GAS FlRED AC UNITS — TONNAGE [A. <br />FORCGD AIR SYSTEMS — � T U M EA <br />WALL HEATERS — B.T.U. M <br />UNITH[ATERS-9TL. M <br />EVAPORAiNECOOLERS <br />CLOiHES ORYEPS <br />VENTILA710N FAN _ <br />RANGEHOOD <br />AIR HANDLING U�lR — CF.M <br />STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />STf7EET SETBACK PEAR VARD SET�nGK �'lnN cntcrc <br />LOT AREA VACANT SITE <br />❑YES ❑NO <br />OCCUAANCY GROUP N0. OF OWELLING UNIiS <br />BUILDING <br />NO. OP STORIES MAX. OCC. � OAD <br />PLUMBING <br />BASEMF�,' FIRE SPRINKLERS <br />ovnwarn MECHANICAL <br />APPROVALS BY DATE """ <br />1. ENVIRONMENTAL CHECK LIST PENALTY <br />2. BUILDING PU1N5 <br />— -- TOTAL <br />3. FIRE HVDRANT <br />a. fIHE PROTECTION SVSTEM PERMIT � <br />WHEN PF <br />5. GRADING <br />6. ORAINAGE <br />). ENVIRONMENTALIMPACTSTATEMENi <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PL4NS CHECKED AV APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />ABEfl PLAN CHECK FEE <br />FEE RECEIPT NO. <br />FEES VALUA710N FEE <br />b12�0.�0 <br />UBC. <br />SEC, 303 (a) <br />12 100 <br />12 p0 <br />VALIDATED (IN THIS SPACE) THIS IS VOUR PERMIT <br />4640 E0�2.00'�-�1' <br />� <br />� <br />1'OJR R[CEIf#� <br />T! �At�K 1'OU <br />I 1.�.80 <br />