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,-. <br />d�cErcrgrecn � �O��gTqUCTION <br />CITY OF <br />everett PE�MlT pERM1T NQ. OH6%O <br />CITY HALL 259�8745 <br />EVERETf. N'A 98201 ❑ COMBINATION ❑ BUILDING x�tMECHANICAI PLUMBING <br />OWNER MAILAOU{iESS CITY ZIT PIIONE <br />Ray O. Bozell 5502 Sunset Lane Everett 98203 353-6043 <br />ARCHIiCCTORDE5IGNEN MAILADDPE55 CIIY ZiP PMONE <br />GENERAI CONiPACiOR MAIL ADDPE55 CITV ZIP FMONE LICENSE 1 <br />Same <br />M[CMANICFL CANTRAC�OP MAIL PDORE55 CIiY ZIP PNONE ULENSE 1 <br />PIUMBiNG CONiRAQOR <br />MA�L ADORESS CIiY ZIP PHONE U('ENSE � <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />S <br />peSCRIBE WORK <br />install Wood Stove <br />onnmSF� lISE OF DUIIDING <br />�or <br />5502 Sunset Lane <br />PLUMBIN� <br />NO. TYPE OF FIXTI <br />nwr unwirvo — n <br />SINK ($ERVICE — BAR, ETC <br />SIDE YAflD SE?BACK STREET SETOACK <br />USE ZONE ��T AR� <br />TYPE OF CONST. OCCUPAdCY GR( <br />SIZE OF OL�:;. N0. OF STOflIES <br />FIREZONE BASEMENi <br />1. [NVIRONMENTALCHECKLIST <br />2. BUILDING PLANS <br />3. FIRE HYDPANT <br />4. FIRE PROTECTION SVSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACi STAT[MENi <br />B. HEALTH DISTRiCT <br />APPUCATION ACC. BY PLANS CHECKED BY <br />FEE <br />REAH YARD SETOACK <br />I 4EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPL�ED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. TH[ GRANTING OF A PERMIT DOES N0T <br />PRESUME TO GIVE AUTHORITY TO \'IOLATE OR CANCEL THE PRO� <br />VISIONS OF ANY OTHER STATE OR LOCAL IAW REGULATING <br />CONSTRUCTION OR THE PERFORMANGE OF CONSTRUCTION. <br />SiGN4i OGGONiRnCTORORAUiHORIZE�AGENT �A�� <br />„ �_. ,�J _�/ 12/9/80 <br />TYPE OF E�UIPMENT FEE <br />AIFi COND. UNITS — HR EA. <br />REFRIGERATION UNIi$ — N.A. [A <br />� OOILEPS — HP. [A <br />G�514RED AC UNITS � TONNAG[ EA <br />FORCE� AIR SYSTEMS — B T U. M EA. <br />WALLHEATGRS—BTLL M <br />UNIT HEAiERS — B T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />\'ENTILATION fNN <br />RANGEHOOD <br />AIR HqNDLING UNIT — ���� �+�- <br />S70VE WOOCj <br />METAL FlREPLACE 8 CHIMNEV <br />SUB TOTAL = 4 <br />PERMIT S 3 <br />TOTAL FEE S � <br />CHECK NUMBER PLAN CNECK FEE <br />VACANi SITE <br />LiVES ❑NO <br />NO.OF DWELIING UNITS <br />BUILDING <br />MAX.00C.LOAD <br />PLUMOING <br />FIRE SPRINKLERS MECHANIC <br />f1E0UIRED <br />❑YES ❑NO <br />BV OATE OTNER <br />PENALiV <br />TOTAI <br />APPR.FORISSUANCEBY <br />V.C. <br />FEE <br />S <br />U.U.C. <br />SEC. 303 (a) <br />RECE�P7 NO. <br />% �S� <br />PROPERLY VALIDATE!1 (IN THIS SPACE) THIS IS YOUP PERMI i <br />tu2�� �OOI.SO-,�Q <br />i.� <br />p / pT � <br />�. _� l�. �\ .:1. i � 1 1� <br />� �,.�•'i: i`l.� U <br />ADDRESS FILE - i UEC $O <br />