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rhr 1_'cer,¢reen <br />7: i;: <br />��erett <br />CITY HALL 254fl745 <br />EVEF�TT, WA 9020t <br />^C�N�TRI�GTION <br />PER11��T <br />❑ COMBINATION LY�t EUILQING ❑ MECHANICAL <br />PERMIT N0. 1'`� � � 7 <br />❑ PLIIMBING <br />01YNER Atqll. ApOFESS GItY ZIP PMONE <br />Eva Sterts 9013 33rd Everett 98201 255-1513 <br />ARCMIiECt OP DESIGNEfi dAiL ADORESS CItY ZIP FMONE <br />GENER�L CONTPACIOR MAIL h��FESS CITV ZIP PMONE �ICENSE � <br />Chris Dfobley Construction 3731 108th Place S.E. Everett 98204 334-7034 <br />tlECHANICAL CONTqACTOF MAIL A�DFE55 CITY ZIP PHON[ LICENSE + <br />CHRShfC183LT <br />PLUMBING CONTRACIOR MAIL AOOiiESS GIiY ZIP PHONE LICENSE � <br />❑ NEW ❑ AD�ITION ❑ ALTEflATION }S� REPAIR ❑ �EMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF YlOfiK <br />S LQiO��.�O <br />DESCfiIBE WORK <br />Repair fire Damaqe <br />single family residence <br />�or_oiucK_oF <br />OB AD�FE55 <br />908 33rd <br />PLUMBING <br />TVPE OF FIXTURE OR ITEM <br />WATER CLOSET ITOILEn <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISH6VASHEfi <br />L.4UNDRYTRAY <br />CLOTHES ND.SHER <br />WATER HEATEF <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOfl DRPIN <br />VACUl1M BREAKERS <br />ROOF ORAINS — RAINLEADERS <br />SINN �SERVICE — BAF, ETCJ <br />SUB TOTAL <br />PERMI7 <br />TOTAL FEE <br />SI�E <br />i. ENVIRCNh1ENTAL CHECK LIST <br />2. �UIL�ING PLANS <br />3. FIFE HYORANT <br />a. FIRF. PROTEC710N SYSTEM <br />5. �RADING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />B. HEALTH �ISTRICT <br />APPLICATION ACC. BV PLANS CHECKED <br />FEE <br />� <br />5 <br />5 <br />REAR YARD SETBACK <br />VACANT SITE <br />_YES NO <br />NO. C= D�VELLING UNITS <br />MAX.00C.LOAD <br />FIP,�9 SPRINKLERS <br />REGUIRED <br />YE'S :NO <br />BY DATE <br />APPR. WR ISSl1ANCE Bf <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAIAINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORHECT. ALL PFOVISIONS OF LAWS AND ORDINANI:ES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPL�ED WITH <br />WHE?S IEfi SPECIFIED NEREIN OR NOT. THE GRANTING OF A <br />PERMIT �OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL TI1E PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONST(�UCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATUHE OF QO17TFI.Gi9RDA AViHORREO AGENT OATE <br />X -- % /%:!i �=�. <br />MECHANICAL <br />AIR COND. UMITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />�OILERS — M.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSiENS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. h1 <br />UNI7 HEA7EflS — 0 T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VEflTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIIANEY <br />FIREPLAJEINSERT <br />HEAT PUMP <br />PLAN CHECKNUMBER <br />fEES <br />�UILDING <br />PLUMBING <br />;AECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE <br />SUBTOTAL SI <br />PERMIT 11 <br />TO7AL FE� S <br />PLAN CHECK FEE <br />i FEE I RECEIPT N0. <br />� VALUAT:ON FEE <br />S 1���0�. <br />(a) <br />'�� <br />� <br />PERMIT VALIDATION <br />WHEN PROPERLV VALIDATED (IN THIS SPACE) TffI51S YOUR�PERMIT [�ti. <br />. . , . � ' _' _�� � <br />`� <br />`C�' <br />� <br />i' `� <br />Ai)DI;� ;5 I�iL!- <br />z I <br />0 <br />-a <br />c� <br />m <br />