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fiP F.lrT-)E.Trrl C INSTRUCTION <br />1111 ITI <br />everett PERMIT PERMIT NO. 18908 <br />259-8745 <br />❑ DEMOLITION I 1 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />ai <br />OWNER KIAII. ADDIiLSS 1'J'v ZIP PHONE, <br />Ruby Kloster <br />ARCHHLCT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />MECHANICAL CONTRACTOR <br />Clly ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CllT ZIP PIIONF LICENSE.[ <br />Crafts Plumbing 17-25 21 Ave. sr RDthelI _qa2n2 755-Rn19 CDAi'TR'G4aU <br />CLASS Or WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION I I REPAIR 7 DEMOLITION U BUILDING RELOCATION <br />f <br />DESCRINE W'OnK <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE <br />PROPOSED USE or BUILDING -- <br />Le GAI DE SCnIrT ION Or PRo.'E RI Y (SE <br />LOT - BLOCK Of <br />Joe AnMESS <br />1 .1.1n Crnnir nr <br />❑ OTHER <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 GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTR OP AUTHORIZED AGENT. OR OWNER DATE <br />X 1,411 - VQ' CaP l01 - 87 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET )TOILET) <br />5 <br />00 <br />!. C A4/NDLG LINITS - H P <br />BATHTUB <br />REFRIGEPATION UNITS -- HP EA <br />LAVATORY (WASH BASIN) <br />5 <br />DOILFRS - B T U'FI P <br />.,HOWER <br />GAS FIRED AC UNITS -BTU <br />KITCHEN SINK Z DISP. <br />FORCED AIR SYSTEMS - B T U M EA <br />DISHWASHER <br />VVALL HEATERS - BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS - B T U M <br />CLOTHES WASHER <br />5 <br />oo <br />EVAPCAA T IVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />FLANGE HOOD <br />BACKFLOW PREVENTERS <br />i <br />WATER HEATER <br />ROOF DRAINS -- RAINLEADEP.S <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />I METAL FIREPLACE IT CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />25 <br />no <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />$ <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE Of CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />25 <br />OO <br />SIZE OF BLGG <br />NO OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />21 <br />50 <br />FIRE SPRINKLERS REQUIRED Lj YES El NO <br />INVESTIGATION FEE <br />Sec. 304(e) <br />STATE BUILDING SURCHARGE <br />- <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC Pv <br />S.H. <br />PLANS CNECKEDBY <br />APPn FOR ISSUANCE BY <br />DRIVEWAY HERMIT <br />TOTAL <br />4 <br />50 <br />PcoNIT VAI IDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT <br />00 <br />Q) <br />00 <br />r' <br />AUJr.E'- I <br />