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the Evergreen <br />��T� �F <br />everett <br />qTY HALL 259�8745 <br />EVERETT. WA 98201 <br />r- �ONSTRUCTIO�`' <br />PERM�T <br />❑ COMBINATION �i BUILDING ❑ ME:HANICAL <br />l! <br />PERMIT N0. 12127 <br />❑ PLUMBING <br />OWNER MAILAODRESS l'ITY 21P PNONE <br />ROBERT A HIBBARD 3201 - 20th St Everett WA 98201 252-6981 <br />ARGMITECT OR OESIGNER MAIL AOOFE55 QTY ZIP PHONE <br />GENERAL CONTHAGTOR MAIL ADr,�c55 CiT/ ZiP PMONE IICENSE I <br />Same <br />AIEGMANICAL CONTRAGTOR MAII P.:pPE55 dT1 ZIP PHONE LICENSE � <br />PLUMBING LONTflACTOfl MAIL ADDRE55 QfY ZIP PHONE UCENSE � <br />__'_' _. .._ <br />❑ NEW O ADDITION ❑ ALTERA710N W� REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />y rJ�O.�� <br />DESCHIBE WORK <br />Reroof - composition <br />le familv residence <br />i0T_BLOCK_OF <br />PLUMBING <br />N0. � TYPE OF FIXTURE OR <br />—�A7ER CLOSET (TOI LEn <br />SHOWER <br />KITCHEN SINK 8 �ISP. <br />DISHWASHER <br />LAUNORVTRAY <br />CLO7HES WASHER <br />WATER HEATER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR ORAIN <br />ROOF DRAINS — RAINLEA�ERS <br />SINK (SERVICE — BAR. ETCJ <br />SUB TOTAL <br />PEqM17 <br />TOTAL FEE <br />AVPNOVALS <br />7. ENVIRONMENTAL CMECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROiEC71pN SYSTEM <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEALTH DISTRIC7 <br />ACC. BY I PLANS CHECKED BY <br />FEE <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORP�CT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVEP,NING 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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF GONTRAGTOF OR�y iHORIZE� 4GENT DATE <br />X ��n_.�9`/�� �/�`� �w� 6/23183_ <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT <br />AIR COND. UNITS — M.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIFiED A.C. UNI7S — 70NNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WAL� HEATERS — B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VEN7ILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNI7 — C.F.M. <br />STOVE — WOOD <br />METAI FIREPLACE 8 CHIMNEY <br />FIFEPLACE INSERT <br />HEA7 PUMP <br />S <br />S <br />5 <br />REAR YARD SETBACK FLAN <br />VACANT SITE <br />:-!YES I:NO _ <br />IdAX. OCC. <br />BY <br />ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENAL7Y <br />TUTAL <br />SUB TOTAL S <br />PEHMIT S <br />TOTALFEE f <br />PLAN CI <br />FEE <br />VALUATION <br />$5��.�� <br />U.B.C. <br />SEC. 303 lal <br />RECEIPT ND. <br />FEE <br />PEHMIT VALIDA710N <br />WHEN PROPERLY VALIDATED (IN 7HISg 4A�E�j THIS � xO�F�Ejjh�T ��(�y , <br />�� �� V U V � <br />� <br />N <br />YOUR RECEIPT� <br />THA(�1K YOU <br />ADDRE55 FILE <br />23�83 <br />_ � <br />