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r� a,ag.,e� <br />CITV OF <br />everett <br />259-8745 <br />'�°` P�JNSTRUCTION '�` <br />PERMIT <br />PERMIT NQ: -. I � � � J <br />❑ OEMOLITION ❑ COMBINATION ❑ BUILDING �,kMECHANICAL fl PLUMBING ❑ SIGN <br />OWNER MAiIRODRESS CITY ZiP PnONE <br />Daniel F. Simrtu 5105 Wilmington Everett 98203 252-6356 <br />�RCHiTECT OR DESiGN[N MAII ADDRE55 CiTY 2iP PHONE <br />GENERRL CONTRACTO� MAIL RDDRE55 CITY 2iP PHDNE LICENSE • <br />Bergman & Son 3702 219th St. S.W. Mountlake Terrace 98043 778-4112 <br />MECNRNIC�ICONiRPCiOP MRILR��PESS QTY ZIP PHON[ UCENSE� <br />BERG-MS-C210R6 <br />PLUMBiN.LONTPnCTOF MPRADDPE55 Cltt 2iP PHONE LICENSEe <br />CUSS OF WORN <br />❑ NEW ❑ AODITION ❑ ALTERATON ❑ REPA�H ❑ DEMOi.ITIC�I ❑ BUILDING RELOCATION <br />VAW4T�ON OF WONR <br />f 1�6�0 <br />DESCRIBE WORN <br />Wood burm�ng fireplace insert "Covntry Comfort" <br />HE4TSOUPCE <br />❑ ELECTRI:;ITY ❑ GAS ❑ WOODSTOVE ❑ OTMER <br />residence <br />EGAL D[SCRIPTION Of vqOPERT <br />�o* �i3 eiocK _ o� <br />Sl�$ W1 <br />PLUMBING <br />, Everett <br />NO. TYPE OF FI%TURE OH ITEM <br />WATER CLOSET �TOILBT� <br />BATIITUB <br />LAVATORV�W45H DASIN) <br />SHOWER <br />NITCMEN SINK 8 OISP. <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINNING FOUNTAIN <br />FLOOR OFAIN <br />BACNFLOW PREVENTERS <br />ROOF DRAINS — flA1NLEADERS <br />SW K �SERVICE — BAR. ETC � <br />use zor+E <br />TYPE OF CONST. <br />SIZE OF pLOG. <br />FIRE SPRINKLERS P <br />APPUCRTION FCC OY <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />nenR seto� crc <br />LOT APEA <br />OCCUPANCYGROUP <br />NO OF STOfiIFS <br />1 <br />) ❑ VES ❑ NO <br />PL/+NS CM[CKEU DY <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GUVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIFD HEFEIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO 31VE 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 />SIGNRTUFE /OF� CONTRRCiO UTHORI26�\� �r1[NT.OR ONNEN pATE^/� <br />X 1/ CY A�S�t1 � ] �/ii' � t1+ % l� ! �y • <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A. C-- A-HNDLG UNIiS — H P. <br />REFRIGEFATION UNITS — H.P EA <br />BOILERS — 8 T.0 /HP. <br />GASFIREDAC UNITS—O.TU. <br />FORCED AIR SYSTEMS — 0 T.0 M EA <br />WALLNEATERS—BTU. M <br />UNIT HEATERS — 0 T.0 M <br />EVAPORATNE COOLEfiS <br />CLOTHES DIiVERS <br />VENTILATION FnN <br />RANGEHOOD <br />WATEfi HEATER � <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />1 FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />E%NAUSTF4N <br />Vl.CANT SITE <br />Lr[s ❑rvo <br />NO O� OWEIIING UNITS <br />1 <br />h1A% OCC.lOAO <br />PPPq GOR ISSUTNC[ [IV <br />SUB TOTAL <br />PEflMIT <br />FEES <br />�UILDING <br />PLUMBING <br />MECHANICAL <br />INVESTIGATION FEE <br />STATE BUILDING SURCHARG <br />STATEENERGVSURCHARGE <br />DRIVEWAV PERMiT <br />$ <br />Sec.304�e) <br />FEE <br />TOTAL I I <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATLD �IN THIS SPACE) THIS IS VOUR PERMIT <br />i;DdiY:1S f II � <br />� � 1 <br />7 <br />