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the ErrrRreen ^p N ST R U CT I O N <br />Ciiv OF <br />everett PERMIT PERMIT NO. 11y15 <br />CITV HALL 259$7�5 <br />EVERETT,WA90201 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MRILAOORE55 CITY ZIP PHONE <br />Koutlas Land Co. Inc. 2925 Chestnut Street Everett 98201 252-3725 <br />ARCnITECT OR DESIGNEF M41L ADORE55 CITY ZIP VHONE <br />GENERALCONTR�GTOR MRIL�DORE55 CITY 21P PHONE LICENSE� <br />Same <br />MECN�NICAL CONTRACTOR MAIL ADDRESS QTV 21F PHOA[ LILENSE I <br />PLUMBIHGCONTflAG10R MRI' ADORGS$ GITY ZIP PHONE UCENSE• <br />S <br />V O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR XIDEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD SiOVFJFIREPLACE INSERT <br />OF WORK <br />Move Residence to 4520 Grand Avenue <br />EGRL DESCRIPTION GF PPOPERTV �SMOW BELOW OR RTTPCH FOUR COPIES� <br />�ot89 eiocK 1 oFSmyth's Land Co,s 2nd <br />IOB ADORE55 <br />3802 Rucker Avenve �r "0"`��-�� <br />PLUMBINO <br />NC�. TYPE OF FI%TURE OR ITEM FEE <br />BATHTUB <br />SHOWER <br />KITCHF.N SINK 8 DISP. <br />DISHWASMER <br />LAUNDflYTRAY <br />CLOTHES WASMER <br />WATER HEATER <br />URINAL <br />DRINKING FO!1NTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINI <br />SINK ISERVICF — BAR, <br />SUB <br />TOTAI FEE <br />SIZE OF BLDG. NO. OF STORI <br />FIRE ZONE BASEMENT <br />APPROVALS <br />1. ENVIROIJMENTAL CMECK LIST <br />2. BUIIDING PLANS <br />9. FIRE HYDRANT <br />d. FIRE PROTECTION SYSTEM <br />, S.GRADING _ <br />6. DRAINAGE <br />7.ENVIRONMENS'ALIMPACTSTATEMENT <br />8. MEALTM DISTRICT <br />APPLICATION ACC. BY PLANS CME <br />f <br />S <br />S <br />YES . NO <br />OCC. <br />NO <br />DPTE <br />FORISSUANCE BY <br />L - <br />I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br />APPUCATION AND KNOW THC 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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LUCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CO TIQN. <br />crwe�nw�wc[:nNiRaf Rl1THOflIZEDrGEN1 DATE <br />3 <br />u0. TYPE OF EOUIPMENT <br />AIF COND. UNITS — H.P. EA <br />REFRIGEHATIOI! UNITS — H.P. EA. <br />BOILERS — M.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.II. M <br />UNIT NEATERS — B.T.U. M <br />EVAPOflATIVE COOLERS <br />CLOTMES DRYERS <br />VENTILA710N FAN <br />RANGEHOOO <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL f <br />PERMIT f <br />TOTAL FEE f <br />fEE RECEIPT NO. <br />VALUATION FEE <br />BUILDING S 00 00 <br />PLUM6ING <br />MECHANICAL <br />OTHER <br />PENALTY U.B C. <br />SEC. J03 (a) <br />TOTAL 00 00 <br />PERMIT V0.LIDR710N <br />WIiEN PRGP[RLY VALIDATED (IN T�SeSP,(��E) THI�I^�YJ�11J(i f��1T � <br />7 l U V V V <br />� <br />. � <br />YOUR RECEIPT � <br />THANK YOU <br />ADDRESS HLE <br />22�83 <br />