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r �hr £�rrxreen - � O N ST R U CT I O N <br />U�ror � <br />everett PERMIT PERMIT NO. 12100 <br />CITV MALL 259�B7d5 <br />EVERETT.WA9B201 � COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING <br />ON'NER MAIL AODRE55 CITY ZIP PHONE <br />DAVZD GOLLER 2606 SUMMIT EVERETT <br />ARGMrtECT OP OESIGNEN MAIL ADORE55 CITY 21P PMONE <br />GENERnL GONLRAGTOR MAIL ADDRE55 QiY 21P PMONE LIGENSE � <br />MECHRNIGAL CONTRRGTOR MAIL ADDRESS CITY 21P PNONE LICENSE R <br />N G E <br />PLUMBING LONTRALTOR MPIL nDDRE55 CITY ZIP PMOrvE LIGENSE � <br />s <br />�or <br />❑ NEW O ADDITION ❑ ALTERATION �.J REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVFJFIREPLACE INSERT <br />INSTALL WATER HEATER <br />2606 SUMMZT <br />191�1;.I:7C[H <br />�ATHTUB <br />LAVATOflY�WASH 9ASIN) <br />SHOWER <br />NITGHEN $INH & DISP. <br />DISHWASMER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF ORAINS — RAINLE <br />SINK �SERVICE — BAR, E <br />PERMIT <br />TOTAL FEE <br />EET SE1'BACK <br />1. ENVINONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HVDRANT <br />d. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />i� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />FOURCOPiES� COHRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL TH[ FHOVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW RE6ULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGN'A/TURE OF CONTPF :tOR OR AUtNOR12ED AGENT OATE <br />X f1r.�-��l���i��IicGr„�. . 6/15/83 <br />3 <br />f <br />f <br />AIR COND. UNITS - F.0. CA. <br />REFRIGERATIJN UNITS - H.P. EA. <br />BOILERS - N.P. EA. <br />GAS FIREO A.�. UNITS - iONNAGE EA. <br />FOflCED AIR SYSTEMS - B.T.U. M EA. <br />WALL HEATERS - B.T.U. M <br />UNIT HEATERS - B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTMES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR NANOLING UNIT - C.F.M. <br />STOVE - WOOD <br />IdETAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />VARDSETBACK �PLAN CMECK NUM�ER <br />�CANT SITE <br />YES NO <br />BY <br />FOR ISSUANCE BY <br />i� <br />FEES <br />BUILDING <br />PLUM8ING <br />MECMANICAL <br />OTMER <br />PENALTV <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FLAN <br />FEE <br />VALUATION <br />S <br />���� <br />��1 1� <br />��' rn <br />RECEIPT NO. <br />FEE <br />T°T"� I I 1� 50 <br />PERMIT VALIOATION <br />WHEN PROPERLY VALIOATED pN TM�$ �Pp.C�� THI�I�Y�Ujl P�f�11T Q <br />a �a � y u � <br />� <br />N <br />YOUR RECEIPT�-+ <br />� i-if�NK YOU <br />n,o�H���s rnt�: <br />I 5 � 83 <br />