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`�� �- ('��NSTRUC'F�ON y � � 1 n q <br />everett PERMIT PERMIT NQ: _ 1�l' �! <br />�� �1-88�0 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 7�7 MECHANICAL ❑ PLUMBIN(� ❑ SI6N <br />OWMEN MAILROORESS GITY ZIP PMONE <br />Jamee R Dutton 5112 Rucker Ave Everett WA 98203 258-1088 <br />•NCNITECTONDESIGNER M�ILADDRE55 CITY 21P PIIONE <br />GENEMLCONTMCTOR MRIL��DPE55 C�TY 21� PHONE LICENSE• <br />MEGMANICAL CONTR�GTOR MRIL �DORE55 CITY 21P PMONE 4CENSE � <br />Seattle Fireworda 16809 Hwy 99 Lynnwood, WA 98037 745-2744 ��- <br />PLUMBING CONTR�CTOR M�IL F�ORESS LITY ZIP ' FNONE lif.ENSE � <br />� � _ _ ' �_ � w <br />CLASSOf WORK <br />❑ NEW ❑ ADDITION <br />VALUATION OF WORR <br />i <br />pESCRIBE WOAN <br />Install woodetove <br />❑ ELECTRICITY ❑ GAS <br />anoroseo use or euaoiNc <br />sinqle famtly realdence <br />IEG�L DESCRIPTION OF FNOPERTY ISNOW BEL01 <br />LOT _ BLOCN �_ OF <br />JOBADORE55 <br />5112 Rucker Ave. <br />PLUMBING <br />NO. TYPE OF FIXTUPE ON <br />WATER CLOSET (TOILET� <br />BATMTUB <br />LAVATORV�WASH BASIN� <br />SMOWER <br />KITCMEN SINK 8 OISP. <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTF.RS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR. ETC.) <br />SUB TOT/ <br />CERMIT <br />TOTALFE <br />FRONTSETB�CR AE�PSEtOAt� <br />USEZONE LOTnREN <br />IYPEOFCONST. OCCUPANGY( <br />❑ ALTERATION <br />•PPLICATIONACCBY ,�PLANSCHECNEOOY <br />M.M. <br />❑ HEP�IR <br />❑ WOODSTOVE <br />COPIES� <br />❑ DEMOLITION <br />❑ OTHER <br />❑ BUILDIN� RELOCATION <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 AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GPANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL �AW REGULATING CONSTRUCTION OR <br />XHE PEF;FORMAN� F�C�DI�TR� ON. � <br />SIGNPT�FCONTRnLiO UTjdA1ZE�/AGENT R WNER DATE <br />��./h«_,. ' /,�i �.z3-8% <br />TYPE OF EOUIMMEN7 <br />A/C — A�HNDLG UNITS — MP <br />REFRIGERATION UNITS — H.P. EP. <br />BOILEAS — B.T.0 /M.P. <br />GAS FIRED A C. UNITS — B TL. <br />FOFCED AIR SYSTEMS — 8 T.U. M EA. <br />WALL HEATERS — BSL. M <br />UNITMEATERS—BT.U. M <br />EVAPORATNECDOLERS <br />CLOTMESDFYERS <br />VENTILATION FAN <br />RANGEHOOD <br />IVATER HEATER � <br />WOODSTOVE <br />METAL FIREPIACE 8 CHIMNEY <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />CNECKNUMBER FEE <br />VRCANT SITE <br />❑VES �NO <br />NOOFDWELIINGl1NiT5 BUILDING <br />_ PLUMBING <br />FEES VALUATION <br />f'UL�J�, �._ � <br />C.. 7 <br />f t.:- .: � . <br />FEE <br />MECHANICAL 3O OO <br />INVESTIGATION FEE �� �1�1 <br />STATF BUILOING SURCNARGE <br />STATEENERGYSURCHARGE <br />APPP iOR iSSUnNCE OY <br />�RIVEWAV PERMIT <br />TOTAL 30 00 <br />VERMIT VALIOATION <br />WHEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS VOUR PERMIT L` <br />N <br />O <br />O) <br />� <br />AUDRESS H!.E <br />