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the Euergreen <br />C�TY OF <br />everett� <br />259-&745 <br />`� C'°'�NSTRUCTION -�= '� <br />PERMIT <br />PERMIT NO. � S 7 � G <br />❑ DEMOLITION ❑ COMBINATION �J BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />OWNER MAILADDFESS CITY ZIP PMONE <br />William A Tjerne 2009 21st St Everett, WA 98201 259-6414 <br />ANCMRECTOHDESIGNER MAILAOORESS CiTY ZIP PMONE <br />GENERALCONTRACTOR MAILAO�RE55 CITY ZIP PNONE LICENSE• <br />Everett Builders, Inc. 5606 Evezgreen Way Everett, WA 98203 353-7161 EVEREB301FH <br />MECMANICALCONTRACTOR � MAILApORE55 pTY 21P PNONE LICENSE• <br />Pll1MBINGCONTRACTOR idAILApDRE55 dTY 21P PHONE LILENSE� <br />GUSS OF WORN <br />❑ NEW ❑ ADOITION C� ALTEHATION ❑ REPAIR ❑ DEMOLITIUN ❑ BUILDING flELOCATION <br />56400. <br />DESGRIBE WORN � <br />Install vinyl siding on residence (20 sq) <br />HEATSOURCE <br />❑ ELECTHICITY ❑ GAS O WOODSTOVE ❑ OTHER <br />single family residence <br />LOT _ BLOCK _ <br />JOBAOORE55 <br />2009 21st St <br />PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />WAiER CLOSET �TOILET) <br />BATHTUB <br />LAVATORY�WASHBASIN� <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />IAUNDRVTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEAOERS <br />SINK �SERVICE — BAR. ETC.� <br />USEZONE <br />TYPE OF CONST. <br />SIZE OF OLDG. <br />FIRE SPfiINKLERS R <br />AFVLICATION qCC �Y <br />M.M. <br />SUBTOTAL <br />PEPMIT <br />TOTALFEE <br />OCCUPqNCV GqOtIP <br />NO. OF STOPIES <br />) ❑ YES ❑ NO <br />PLr1N5 CMECKED BV <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIIJED THIS <br />APF_ICATION 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 HEFEIN OR NOT. THE GRANTING OF A <br />PEflM1T 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 />SiGNAT`�i F WNTRACIOnRnrIUTHORIZED AGENT. OR OWNER DATE <br />X � ait?��. vvi n�U�� B/26/87 <br />MECHANICAI <br />FEE NJ. TYPE OF EOUIPMENT <br />A%C — A/HNDLG UNITS — H P. <br />REFRIGEliATION UNITS — H P. EA. <br />BOILERS — BSL./H P. <br />GAS FIRED A.C. UNITS — BS.U. <br />FORCED AIR SYSTEMS — BS.U. M EA. <br />WALL HEATERS — 6 T.U. M <br />UNITMEATERS—BTU. M <br />EVAPORATiVE COOLERS <br />CLOTHESDHYERS <br />VENTILATION FAN <br />RANGEHOOO <br />WATERMEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACGINSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />VACFNT SITE <br />❑YES r]NO <br />r�r �roweuiNcu��rts <br />ov <br />SUBTOTAL <br />PERMIT <br />PLANCHECK NUMBER <br />FEES <br />BUILDING <br />PLUMBING <br />MECNANICAL _ <br />INVESTIGATION FEE <br />STATE BUILDING SUFC!1ARG <br />STATEENERGYSURCIIARGE <br />DRIVEWAV PERMIT <br />FEE <br />FEE RECEIPT NO. <br />VALUATION FEE <br />�' 6400. r 90 00 <br />- Se[. 304(e) ' - I <br />TOTAL I I <br />PERMIT VALIDATION <br />WHEN PROPERI.Y VALIDATED pN iHIS SPACE) ThI151S YOUR PERMIT <br />5� <br />N <br />� <br />N <br />OD <br />� <br />