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CITY OF EVERETT <br />�.ONSTRUCTION <br />PERMIT <br />PERMITNO 27473 <br />�� 259-8810 ' <br />C' DEMOLITION ❑ COMBINATION QBUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILAD�RE$$ CITY ZIP PHONE <br />R. D. KULBECK 1019 Slst PL SW EVERETT 98203 258-1975 <br />TENANT MAILADORESS Cliv 21P PHONE <br />MAILAC�RE55 <br />CITY ZIP PMONE <br />GENERAICONTPACTOR IdAILpD�FE55 CITY <br />QUALITY ROOFING 6404 BEVERLY BLVD EVERET': 98203 355-9345 <br />'dECHANICAL CONTRACTOR MAIL AD�RESS CITV <br />Ci "55 OF WORK <br />❑ NEW ❑ ADDITION <br />MAILADDRE55 <br />❑ ALTERATION <br />$1 REPAIR <br />CONTflACT PRICE OF WORK: $ S� 4O0 I <br />DESCRIBE WOPK AND SOUARE FOOTAGE INVO�VED <br />Reroof existing bldg <br />arr <br />Z�P AHONE LICENSE M <br />QUALIR226BK <br />Z�P PHONE LICENSE Y <br />ZIP PMONE �ICENSE / <br />❑ DEMOLITION ❑ BUILDING RELOCATiON <br />r!D PHONE N0. IF OTMER THAN ABOVE <br />PROPOSED USE OF BUIL�ING - <br />SINGLE FAMZLY RES <br />LEGAL DESCRIPTION OF PqOPERTY ($MUW DELOW OR ATfACH FOUR COPIES) <br />LOT_ BLOCK _ OF <br />oeiozi�i ii:�san aooaaex9e �-z <br />i <br />e�r,c �ei.00 <br />JCBADDRESS <br />1019 S1ST PL S[I <br />PLUMBING <br />NO. TYPE OF FI%TURE OR IT <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVAT� 7V (WASH BASIN) <br />SHOWER <br />KI7CHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRY7RAY <br />CLO7HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTFRS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />PERMR <br />TO7ALFEE <br />FRONTSET�qGh REAqSETBACK <br />USEZONE LOTAREA <br />iVPEOFLONSTFUCiIONAILOWAB�E iVPEOPCONSTRUGT1f <br />S2E OF 6L�G. N0. OF SiORIES <br />OCCUPANCY LOAD FIRE SPFINKLERS fiE <br />o YEs ❑ No <br />FEASONFORSPflINKLERS <br />APPLICATIONACGBY PLANSAPPqOVE00Y <br />MECHANICAL <br />FEE NO. TYpE OF EOUIPMENT <br />A/C —AMN�LG UNITS — H.P. <br />FORC[DAIRSYSTEMS—B.7.U. MI <br />UNITHEATEHS—B.T.U. M <br />CLOTHESORYERS <br />SIDE <br />eccwu:cv <br />caac <br />i5 L] NO <br />HEIGHT LIMITFTION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS <br />3105 <br />WATER HEATER <br />WOODS70VE <br />METAL FIHEPLAI <br />HEAT PUMP <br />GAS FIPING <br />EXHAUSTFAN <br />NUMBER <br />BUIL�ING § 5 4�� <br />PLUMBING <br />McCHANICAL <br />OTH[R <br />STATE BUILDINC SURCHARGE <br />STATEENERGYSUHCHARGE <br />PUBLIC WORKS <br />TOTAL <br />WHEN PROPERLY VALIDATED <br />FEE <br />50 <br />I 85I 50 <br />IS YOUR PERMIT <br />PERMITS EXPIRE IF WORK IS NOT COMMENCED WITHIN 2 7 4 7 3 <br />180 DAVS OR CEASES FOR MORE THAN 180 DAYS. ADDRESS FILE <br />