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the <br />&NSTRUOTIONcof C <br />CC� <br />everett PERMIT PERMIT NQ: _ 1 777 J <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING IT(] MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Raymond f,ergman 5019 27th Ave. W. Everett 98203 745-5509 7 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />MEC4ANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSEE <br />Valley Natural Gas <br />11323 Hwy 99 <br />Everett, WA 98204 <br />355-7730 <br />VALLEYG153LI <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />® NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />$ 1647-54 <br />Install furnace/ water heater <br />1EAT SOURCE <br />❑ ELECTRICITY ❑ GAS 0 WOODSTOVE n OTHER <br />le <br />COPIES) <br />LOT _ BLOCK <br />JOB ADDRESS <br />5019 27th Ave W <br />I HL.uBY 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 SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOF PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL 1HE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR. AUT FIDRIZED AGENT, OR OWNER DATE <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS - N.P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY(WAFI- BI.SIN) <br />BOILERS -DT.U./H.P. <br />SHOWER <br />GAS FIRED A . UNITS - B.T.U. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS -E T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS -BT.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING :=OUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />1 <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC.) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />$ <br />SUB TOTAL <br />15 <br />O <br />PERMIT <br />$ <br />PERMIT <br />TOTAL <br />iECKNUMBER <br />OO <br />TOTAL FEE <br />$ <br />FEE <br />3O <br />FRONTSETBACK <br />REAR SETBACK SIDE <br />74 <br />SETBACK <br />FF--/10/87 4•. <br />/_ <br />`Ndd%7g92 .1*1 <br />USE ZONE <br />LOT AREA VACANT <br />SITE <br />❑ YES ❑ NO <br />FEES <br />FEE <br />BUILDING <br />KECHl1iPG61 <br />r <br />$Gi S <br />• I <br />C <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES I <br />MAX OCC LOAD <br />MECHANICAL <br />-- <br />30 <br />50 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />INVESTIGATL IN FEE <br />Sec. 304(e) <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />S_H <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />30 <br />50 <br />MAMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />Ln <br />L� <br />N• <br />N• <br />ADDHESS FILE <br />