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r� E�� <br />CITY OF <br />everett <br />259-8745 <br />.�. <br />C'�NSTRUCTION � <br />PERMIT NQ: � � � Q � <br />� <br />PERMIT <br />❑ DEMOLITION � COMB�NATION ❑ BUILDING ❑ MECHANICAL 'O PLUMBING ❑ SIGN <br />OWNER MAILFODRE55 CITY ZIP PHONE <br />Henry Hoffman 16020 - 41st Dr NW 5tanwood, WA 96292 652-7943 <br />RRLNITEGiOR0E51GWER MAILAppiiE55 CITY ZiP PHONE <br />Larry Bagley <br />GENERAL CONTqACTOR MAIL PU�RE55 pTV ZIP PMONE LICENSE � <br />Owner <br />MECHANICPL CONTRACTOR MAIL AODRE55 CI�Y ZiP PHONE LICENSE x <br />:lUMBINGCONTRACTOP MAILAODRE55 pTY ZiP PHONE LICENSE� <br />CLA55OF WORK <br />�E] NEW ❑ AODITION <br />VALUATION OF WCRK <br />`44,969 <br />DESCRIBE WORK <br />New construction, residence <br />HEATSOURCE <br />❑ ELECTRICITY ❑ GAS <br />home <br />i.or 1 b �9iocK 354 <br />3305�19th St. <br />PLUM8ING <br />❑ ALTERATION ❑ REPAIR <br />❑ WOODSTOVE <br />St. Nicholas Ad3. <br />TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET� <br />BATHTUB <br />IAVATORY�WASHBA5IN) <br />SHOWER <br />HI'i CHEN SINK 8 DISP. <br />OISHWASHER <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOF �RAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS - RAINLEADERS <br />SINK (SEFVICE - BAR, ETCJ <br />20' <br />USEZONE <br />R-2 <br />TYPE OF CONST <br />V-N <br />SIZE Of OLDG. <br />1092 sf + 440 <br />FIRE SPRINKLEFS REI <br />FPPLICATION ACC DY <br />M.M. <br />SUBTOTAL <br />PEflM1T <br />TOTALFEE <br />REARSETpFCN <br />20' <br />LOT AREF <br />6020 <br />OCCUPANCYGR� <br />R-3 <br />NO.OF STOIilES <br />� <br />��� <br />5 <br />5 <br />1-' + 5' <br />vncnNr sire <br />[jVES ❑NO <br />ND. OF �WELUNG l <br />APPR FOR IS°•UANCE �Y <br />Be <br />❑ DEMOLITION <br />� OTHER <br />❑ BUILOING RELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO DE 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 NOT PRESUME TO GIVE AUTHORITY TO <br />'VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR OFCONTRAQOR,AUTH091ZEOAGfNT.ORUWNER OATE <br />X �i�f+-� ��� �.�� � �� / � A� <br />NO. TYPE OF EOUIPMENT <br />A/C - A/HNDLG UNITS - H P. <br />HEFRIGERATION UNITS - H.P. EA. <br />BOILERS - B T U./H.P. <br />GAS FIRED AC. UNITS - B.T.U. <br />1 FORCED AIR SVSTEh1S - O.T.U. M EA. <br />WALL HEATEflS - 9.T.U. M <br />Uk1T HEATEAS - B T.U. M <br />EVHPORATIVE COOLERS <br />1 CLGTHESDRYERS <br />Z VENfILATIONFAN <br />1 RANGEHOOD <br />1 WATER HEATER � <br />WpODSTOVE <br />METAL FIREPLACE 8 CFIIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXNAUSTFAN <br />SUBTOTNL <br />PERMIT <br />TOTAL FEE <br />N CHECK NUNBER FEE i <br />BS/19607 184.92 <br />BUILDING S <br />a�uMew: <br />nnECHnrncn� <br />INVESTIGATION FEE Sec. 304(e) <br />STATE dUILOING SU�iCHARGE <br />STATEENERGVSUNCHARGE <br />DRIVEWAY P[RMIT <br />FEE <br />PT NO. <br />95495 <br />362 00 <br />45 00 <br />37 50 <br />63 38 <br />3 50 <br />15 00 <br />20 �� <br />TOTAL I I 566I38 <br />PENMIT VALIDATION <br />WHEN PROPERLY VAIIDATED �IN TNIS SPACE) THIS IS VOUR PEfildlT <br />�` <br />� <br />� <br />Q�i <br />� <br />