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theEuCergreoF �° C�NSTRUCTION �� � <br />everett PERMIT PERMITNO. _ 228� 0 <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION 13 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL/OORESS CITV ZIP PHONE <br />Fran Buntting 4504 227th SW Mt. Lk. Terrace 98043 778-3712 <br />TENANT MAILADDRE55 CITY ZIP PIIONE <br />Larry Lacy <br />ARCHITECTOPDESIGNER MAILADDflESS dTY ZIP PHONE <br />GENERALCONTRACTOR MAILqODReSS CITY 21P PHO�iE LICENSE+ <br />Owner <br />MECHANICALCONTflACTOR MAILAGDPESS CITV 21P PHONE UCENSE� <br />PLUMPINGCONTRACTOR M�ILA�DfiE55 LITY ZIP PMONE LICENSE� <br />CLASS OF WORK <br />❑ NEW ❑ ADDIT�ON <br />CONTRACT PRICE OF WORK: $ <br />OESCflIBE W ORK AND SOUARE FOOTAGE INVOLVE� <br />Reroof <br />❑ ALTEHATION ❑ REPAIfl ❑ OEMOLITION Ci BUILDING RELGCATION <br />PROPOSE� USE OF BUILOING <br />Duplex <br />LEGAL OESCRIPTION OF PROPERTY (SHOW BELGW OR ATT�CH FOUR COPIES� <br />LOT - B W CK - OF <br />JOBA�DFESS <br />1009 52nd St. <br />PLUMBING <br />FIXTURE OH ITEM <br />WATER CLOSEf (TOILET) <br />BA7HTU8 <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />URINAL <br />ORINKINGFOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.1 <br />SUB TOTAL <br />PERMIT <br />TOTALPEE <br />FRONTSETBACK FEAR SETBACK <br />USEZONE LOTAREA <br />TYPEOFCONSiPOCfIONALIOWABLE O'PEOFCONSiflULLIONACiOAL <br />SIZE OF p1.DG NO OF STGRIES <br />OCCUPANCVLOAD FIPESPRINNLEPSREO'0 <br />❑ VES ❑ NO <br />REASON FOq SP{iINNLERS <br />FPPROVEDBY <br />S.H. <br />LONTALT PERSON AND PHONE NO. IF OTM[fl TNAN ABOVE <br />MECHANICAL , <br />FEE NO. TYPE OF EQ.. -,.iENT FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FOPCED AIR SYSTEM� — B.T.U. M EA. <br />UNITHEATERS—B.T.U. M <br />CLOTHES OflVERS <br />VENTILA'fION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />�AFTAL FIREPLACE 8 CHIMYEV <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />S� � <br />SI�E SET�ACN <br />VPCANT SITE <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S � <br />PLAN CHECK NUMBER � FEE RECEIPT NO. <br />❑ YES ❑ NO FEFS <br />�'po�;° NOOFCWFIIINGUN115 BUILDING $ 1 <br />PLUMBING • B�SB <br />9n5EMENT <br />❑ VES ❑ NO MECHANICAL <br />HEIGHTLIMITATION OTFiER £L"uG <br />�-�P <br />STATE BUILDING SURCH�RGE <br />STATE ENEFiGV SURCHARGE <br />CITY OF EVERETT pUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS rorn� <br />3105 ....._.. ....,...�... ., ..., ..... <br />FEE <br />�°33�'�f OOOPH7479 <br />�� <br />33 50 ! <br />THIS IS YOUR PERMIT <br />PERMITS EXPIRE IF WORK IS NOT COMMENCED WITHIN , �`� 8�� � <br />ADDRESS FILE <br />180 DAYS OR CEASES FOR MORE THAN 180 DAYS. I <br />