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�hr [i r�vereen <br />everett <br />CITY HAIL 259-87a5 <br />EVERETT. WA 98201 <br />� �ONSTRUCTIO� � <br />PERMIT PERMIT NO. 149�4 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAILApDRE55 CIiY ZIP PHONE <br />Cverett Clinic 3912 Colby Avc. Everett 98201 259-0966 <br />APGNITEGi OR DESIGNER MAIL AD�RE55 CIiY $IP PMONE <br />G11erUe Builders, Inc. P.O. Qos 1851 Everett 9820G 259-6563 <br />GENEP.AI LONiRACiOR MAIL ADORE55 C�iY $IP PMONE LILENSE M <br />MEGNANICAL CONTPAGTOR MAIL AOORE55 CITY ZIP PMONE LICENSE � <br />PLUMBING GONiPAGTON MAIL AODRESS CIiY 21P PMONE IiCENSE � <br />O NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR � OEMOLITION O FENCE ❑ SIGN ❑ VJOOD STOVEIFIREPLACE INSERT <br />VALl1AbON OF 1YORK <br />S <br />DESCRIBE wOfiN <br />Demolish existing structure <br />oanancrn i icc nc nuu niur. <br />�ot_e�ocn_oF <br />14 <br />Cos lst Addn to Hverett D1k005 D-00 <br />3925 Rucker <br />PLUMBING <br />NO. TYPE OF <br />BATHTUB <br />LAVATORY(WASHBASIN) <br />SHOWEfl <br />KITCHEN SINK 8 DISP. <br />DISMWASMER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />HOOF �RAINS — RAINLEAOERS <br />SINK (SERVICE — BAR, EiC.� <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />SIZE OF BLOG. NO. OF STOR� <br />FIRE ZONE BASEMENT <br />APPNOVALS <br />L ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />�. FIRE HYDRANT <br />4. FIRE PROTECTION SYSiEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEALTH DISTRICi <br />APPLICATION ACC. DY PLANS CHE <br />S <br />5 <br />REAR VARD SETE <br />VACANT SITE <br />YES NO <br />NO. OF DWELLIN <br />MAX.00Q LOAD <br />FIRE SPRINKLER: <br />flE0U1PED <br />VES NO <br />BY OA7 <br />BV �APPR.FOR <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 AP�D 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 TG VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />V�t�{ip� F Cq� iR�CiOR OF RUTHOFIIEO AGENT DATE <br />� � l v -�%L-- C��i�.Q C- <br />TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGEHATION UNIiS — H.P. EA. <br />BOILERS — N.P. EA. <br />GAS FIREO G r. UNITS — TONNAGE <br />FOflCED AIR �TSTEMS — B.T.U. <br />WALL HEATEflS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR MANDLING UNIT — <br />S70VE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />M EA. <br />M <br />M <br />QF.M. <br />FEE <br />SUBTOTAL 4 <br />PERMIT f <br />TOTAL FEE 5 <br />PLAN CMECK NUMOER PLAN CHECKFEE <br />FEE RECEIPT NO. <br />FEES VALUATION FEE <br />BUILDING $ <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTV <br />SEC. 303 (a� <br />TOTAL I I I <br />PERMIT VALIDATION <br />WHEN PROPERLV VALIDAiED (IN THIS SPACE) THIS IS YOUR PEflM1T <�- <br />i -N <br />� <br />� <br />�—i <br />AUDkESS FIL[ <br />