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CITY OF rONSTRUCTIQN - q pcn <br />everett PERMT PERMITNQ:I860 - 1 <br />259-8745 <br />❑ DEMOLITION L1 COMBINATION ❑ !WILDING U MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Henry Bacon Bellevue, 4)A 98104 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />MECHANICAL CONTRACTOR <br />MAIL'DORE-, <br />CITY ZIP <br />PHONE LICENSER <br />Indoor Climate 200dNOW <br />1541 S. <br />92nd Pl. Deattle, WA 98108 <br />762-5952 INDOORC3464 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE• <br />CLASS OF WORK <br />0 NEW ❑ ADDITION <br />(I ALTERATION <br />❑ REPAIR ❑ DEMOLITION <br />❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />$ 9000.00 <br />DESCRICE WORK <br />2 Heat Pumps and Duct work _ <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS 0 WOODSTOVE 0 OTHER <br />PROPOSED USE OF BUILDING <br />Bldg. Supplies <br />I HEF,EBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW T SAME TO BE TRUE AND <br />CORRECT. ALL PROVISI LAWS AND ORDINANCES <br />GOVERNING THIS T OF RK WILL BE COMPLIED WITH <br />WHETHER SPEC D OR NOT. THE GRANTING OF A <br />PERMIT DO NOT S E TO GIVE AUTHORITY TO <br />VIOLATE 9 CANCE THE O ISIONS OF ANY OTHER <br />STAT R LOCAL REGUL ING CONSTRUCTION OR <br />TH ERF T CTION. <br />SO ATURE CO C IORIZ A OR OWNER DATES <br />•`CJ <br />LEGAL DESCRIPTION OFF 10-ERTY(SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK _ OF <br />JOB ADDRESS <br />_ 3200 35th Ave. NE <br />PLUMBING <br />CHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />2 <br />A/C - 41HNDLG UNITS - H P. <br />18 <br />00 <br />BATHTUB <br />REFRIGERATION UNITS — H P. EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS — B.T. U.IH P. <br />SHOWER <br />GAS FIRED AL. UNITS — B.T IJ <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS —B T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />13ACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />$ <br />SUBTOTAL <br />18 <br />30 <br />PERMIT <br />$ <br />PERMIT <br />15 <br />00 <br />TOTALFEE <br />$ <br />_^ <br />TOTALFEE <br />33 <br />00 <br />FRONTSETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />IEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT <br />❑YES ❑N0N O <br />_ <br />FEES <br />VALUATION <br />FEE <br />_ <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO FDWELLINGUNITS <br />PLUMBING <br />- <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />/ <br />FIRE SPRINKLERS REQUIRED ❑YES ❑ NO <br />INVESTIGATION FEE <br />-SPc'30a1e) <br />STATE BUILDING SURCHARGE <br />- <br />-- <br />Igo <br />,TATE ENERGYSURCHARGE <br />APPLICATION ACC. BY <br />S.H. <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE <br />L.C. <br />B' <br />DRIVEWAY PERMIT <br />TOTAL <br />33 <br />00 <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUP PERMIT <br />w— <br />C.0 <br />l� <br />ADDRESS FILE <br />