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x' ' rhr £vrrarcen <br />CITY OF <br />everett <br />� CITY HALL P5P87r5 <br />� � CONSTRUGTIC�I � <br />PERMIT PERMIT N0. 15S9b <br />EVEREIT, WA 98201 ❑ COMBINATION ❑ BUILDINO �c MECHANICAL ❑ PLUMBINO - <br />N R MAIL AODRESS qTY ZIP PHONE <br />Pete Held 5114 Glenwoo3 EWerett 98203 259-6077 <br />�RCMITECT Ofl DES16NER MAIL AOORESS CITY ZIP PHONE <br />OENER�L CONTMCTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />MECHANICAL CONTRACTOR MAIL A�DRESS CITV ZIP PHONE LICENSE M <br />$dG1E <br />PLUMBINGCONTPFCTOfl MAILAUOFESS CITY ilP PMONE JCENSEN <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE O SIGN �C WOOD STOVEIFIREPLACE INSERT <br />WORK <br />f <br />LOi_BLOCK_OF <br />�: _ ' <br />PLUMBING <br />NO. TYPE OF FIXTI <br />WATERCLOSET�TOILEn <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 OISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR ORRIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />PEHMIT <br />TOTAL FEE <br />� AFFBOVALS <br />7. EPIVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />a. FIRf.. PROrEC7iUh 5�51 <br />5. G9ADING <br />8. D9AINAGE <br />7. EHVIRONM <br />8. HEALTH DISTRICT <br />Ofi ATfACH FOOR COPIES� <br />S <br />S <br />REAF YAqD SETE <br />VACANT SITE <br />GYES CNO <br />NO. OF DWELLIN <br />M4%.00C.LOAD <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE 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 SPECIFIEO 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 bTATE OR <br />LUCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATjM�0�7y7RACTOR pROUTMORIZED AGENT DATE <br />MECHANICAL <br />TYPE OF EQUIPMENT <br />AIR COND. UNI7S — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILEFS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — 8 T.U. M <br />UNIT HEA7ERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLO7HES DRYERS <br />RANGEHOOD <br />AIR HANDLING UNIT — <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />C.F.M. <br />FEE <br />SUB TOTAL S '] <br />PERMIT � S 10 <br />TOTAL FEF. S 1� <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />FEES VALUATION FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />BY DATE OTHER <br />PENALTY <br />U.6,C. <br />SEC. 303 la) <br />17 I$0 <br />TOTAL I I 17 I SO <br />WHENf PROPFRLY� ALIDATED (IN THIS�S�A�:� TMIS � gO�R�P.FJiM1T---((� <br />� <br />� <br />r�•.. <br />���' .�.: i'.�_C�:����� <br />}� �' U t-� <br />i ....ir� <br />ADDRESS FILE <br />- �� .Jltti U U <br />