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Ihe !i ��rr¢reen <br />evere�t <br />GTY MAII 259�87a5 <br />EVERETT. WF 99201 <br />CONSTRUCTIOP' <br />PERMIT <br />� COMBINATION � BUILDING � MECHANICAL <br />PERMIT N0. ,-3G�3 <br />�I PLUMBING <br />IAAILA�ORE55 LITY ZiP PMONE <br />ov+r+en 98206 337-1317 <br />Gene Fosheim P.O. Box 5234 Everett Z��, PMON[ <br />ARCMIi[Gi OH C[SIGNER MAIL FD�A[55 <br />GENERAL CON1RnGtOR <br />IA/•IL AOOFE55 GITY 21P PNONE LILENSE � <br />Same C�Ty jIP OMONE UCENSE � <br />MEGNANICAI CONiRACTOF MAIL PDDRESS <br />PLUMUING GOHiRACTOR MAIL �DUAE55 <br />GIiY ZiP PnONE UCENSF • <br />CL�55 u� wvnn <br />❑ NEW O ADDITION �ALiERATION REPAIR <br />VALURTiON OF WORK <br />S 2OrOOO.00 <br />Interior remodel of <br />puplex <br />���27-28 599 Wiley Land Co. 4th <br />LOT__BLOLN,_aF <br />�oe nooAEss <br />2620 Walnut <br />PLUMBING <br />), TYPE OF FI%TURE OR ITEM <br />9 WATERCLOSETQOILETI <br />2 DATMTUD <br />Q LAVAIORV(WASN OASIN) <br />SHO\NER _ <br />9 KITCHEN SINK 6 DISP. , <br />LAUNDRYTHAY <br />CLOTNE5IYASHER <br />WATEH HLATER <br />URINAL <br />DRINKING FOl1NTAIN <br />FIOOR ORAIN <br />VACUUM BREAKE9S <br />ROOF C7AIN5 — :7AINLEADERS <br />SINK ISERVICE — BAR. ETC.) <br />SUB TOTAL <br />PERMI �' <br />TOTAt FEE <br />ZON <br />1. ENVIRONMENTAL CMEGK LiST <br />2.BUILOINGPLANS ' �_ <br />3. FIfiE HYDRANT <br />4. FIRE PROTECTION SYSTE/Ae <br />5. GRA�ING <br />6.OFAINAGE <br />i. ENVIIiONMENTAL IIAPACT: �� A'� <br />B�HEALTN OISTflICT � <br />APPLICATION ACC. BY � PLF <br />I i <br />E <br />FEE <br />4 <br />❑ �EAIOLITION ❑ FENCE ❑ SIGN ❑ WOOD StOVHFIFEPLACE INSF.RT <br />APPLICATONTANDTKNOW THE SAME TOEBEnTRUE� ANID <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED WITH <br />PERMIT DOES NOTIPRESUME TO GIVE AUTHORITY TO V OL�ATE <br />LOCAL LAW HREGU�LATINGSC�ONSTR CTIONSOH THE <br />PERFORMANCE OF CONSTRUCTION. optE <br />SIGNAiURE OF GONTRACiOR OA /•UTMOPIZED I.GENT 7/Z4�84 <br />/ <br />X /z,_ �/L L_ <br />MECHANICAL <br />N0. TYPE OF Eomr�n�n i <br />q�q COND. UNITS — H.P. EA. <br />FEFRIGERATION UNITS — M.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. ONIi� — TONNAGE EA. <br />FORCS� AIR SYSTEMS — B T.U. M EA. <br />IVALL HEATERS — B.'.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATNE COOLERS <br />CLOTHES DRVERS <br />Z VENTILATION FAN <br />Z qANGEHOOD <br />AIR HANPLING UNIT — QP.M. <br />STUVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />. FlBEPLACE�NSEHT <br />FEAT PUIdP <br />f:j 361Q0 <br />EAR YARD SETBACK PLAN GMECKI <br />'ACANT SITE FI <br />YES NO — <br />�O. OF DWELLING UNITS <br />BWLDING <br />dAX.00Q LOAD <br />PLUMBINC� <br />=1RE SPRINKLERS MECHANICAL <br />7EOUIREO <br />YES NO <br />BY OATE �TMEA <br />PENALTY <br />FPPR. <br />SUB TOTAL <br />PEflMIT <br />TOTALFEE <br />P <br />FEE <br />VALUATION <br />s20,000_ <br />u.ec. - <br />SEC. 703 �&1 <br />FEE <br />i 24 �0 <br />f <br />s 24 00 <br />GMECK FEE <br />RECEIPT NO. <br />FEE <br />_ 140 $0 <br />36 00 <br />ia o0 <br />140 50 <br />TOTAL � � _ <br />PERMIT VALIDATION <br />l"JHGN PROPE,PLYi yAL�DA4ED �IN THI$ SPAGfiI THISOS t10�1F�PEf7h11T___ � <br />( � �'� l � � � ' <br />i� <br />C7 <br />I'� ��i <br />4 <br />�- <br />r <br />r: <br />