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lheEvergreen � �NSTRU�TlUN <br /> GITY OF <br /> eve�rett pERMIT PERMITNO. ZO1 � 4 <br /> 259 - 8745 <br /> ❑ DEMOLITION � COMBINATION L BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> owNcvv niai�000ness arr ziW rHor+E <br /> 5 �ec Homes )P.O. Hox 708 Mukilteo, 96275 338-0335 � <br /> ABCHITtCT OP�ESIGNER MNL ADDnE55 CiTY ZiP PHONE i <br /> G[N[RAICOtJTRACTOfI MAII F��RE55 CItY ZIP PHONE LICENSEa <br /> Owner SELECH*123DS <br /> MECHANICfLWNTlIAQOR IANl4J�RESS QTY ZIP PHONE LICENSEe <br /> PLUM0INGCONTRRGTOR MAtLADOPE55 CITY ZIP PHONE IICEVSEu <br /> CLASS OF tVORK <br /> � NEW ❑ P.ODITION ❑ ALTERATION ❑ REPAIFl ❑ DEMOLITION ❑ BUILDING PELOCATION <br /> VA W NTIOIJ OF 140PK <br /> s 4�,200.00 <br /> DESCPI�E WORK . <br /> New Construction Basic The Elm <br /> HERTSOURCE I <br /> ❑ ELECTRICITY ❑ GAS ❑ WOOOSTOVE ❑ OTHER � <br /> � <br /> aaoNweo use aF ew�oiNc I <br /> Single family residence I HEREBY �ERTIFY THAT I HAVE REAU AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND � <br /> iecnioesceianoNOFanoaen.ris��owoe�owonaTtncr+councovies CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES I <br /> io. 37 o�ccK _ or �rson PaYk GOVERNING THIS TYPE OF WOflK WILL BE COMPLIED WITH <br /> — WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A � <br /> PERP.IIT DQES NOT PRESUME TO GIVE AUTN'�RITY TO I� <br /> — VIOLHTE OR CANCEL THE PROVISIONS OF A�JY OTHER �. <br /> STATE OR LOCAL LA�"' REGULATING CONSTRUCTION OR ' <br /> THE PERFORMA''.;E OF CONSTRUCTION. <br /> JOp ADDPESS SIGY�TURE OF CONTf . U IiORIZED AGENT.OR OWNER _ DATE <br /> 10717 lOth Dr. SE }( <br /> PLUMBING MECHANICAL � <br /> N(1. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET�TOILET� LO OO �iC—ArHNDLG UNITS—H P. <br /> _� BATHTUB S OO REFRIGERATION UNITS—HP.EA _ <br /> LAVATORV�WASH F3ASIN� LO OO IiOILERS—B.T.0-H.P. <br /> _� SHOWER S OO GAS FI�iED AD.UNITS—B TL. <br /> KITCHEN SINK 8 DISP. S OD ]_ PORCED AIR SYSTEMS—BS.U. M EA. 9 OO <br /> �ISHWASHER S OO W�LL HEATERS—�S.U. M <br /> LAUNDRY TRAV UNIT HEATEFS—�T.U. �d <br /> CLOTHES WASHER S OO EVAPORATIVE COOLERS <br /> URINAL ]. CLOTHES ORVERS C� SO <br /> DRINKING FOUNTAIN 2 VENTILATION FAN 9 BO <br /> FIOOR DRAIN 1 HANGE HOOD ^ "6 SaK:k::#::� <br /> BACKFLOW PREVENTERS 1 WATER MEATER 6 SO <br /> ROOF DRAWS—RAINLEA�ERS WOOD STUVE <br /> SINK�SERVICE—BAR.ETC.) 1 METAL FIREPLACE 8 CHRdN � $O OO <br /> FIREPLACEINSERT � � <br /> _ HEAT PUMP } <br /> GAS FIPING �� <br /> E%HAUSiFAN <br /> � � <br /> SUB TOTAL s qs sua r z 67 50 <br /> PERMIT S PERM [S, <br /> TOTALFEE 5 TOTA G�J SO <br /> FnoNi SeroncK nenn SEronCK SioE sE�[lncrc PLAN CHECK NUMBER FE� SFCH ��IPT NO. <br /> �n 87/18910 [ �� S 5.00 <br /> usE zorve �or nqen <br /> vncnNi si�e FEES TION • FEE <br /> $MES ❑NO <br /> � O. <br /> TYP[OFCONST OCCUPANCYGROIIP NOO�OWEIUNGUNITS �UILDING S 39 Q(� <br /> V—N R-3 1 pLUMBING <br /> SiZE OF[1LDG NJ OF SrpRIEc MA% OCC LOAD � �0 <br /> 1034 1 N/A MECHANICnL 67 50 <br /> INVESTIGnTION FEE Sec.301�e) <br /> FIRE SPRINKLEHS REOl11RED ❑VES NO <br /> S7A7E�UI!DING SURCHARGE 5 <br /> S7ATEENERGVSURCHAHGE 1 00 <br /> AFPLiC�T�ON�GC [3Y PLnNS CMECK[0 E3Y APPR FOR ISSl1ANCE�Y <br /> DRIVEWAY PERMIT Z OO <br /> TOTAL <br /> S.H. B.E. B.E. 4 <br /> — PERMIT VALIOATION <br /> bV11LN PROPERLY VALIDAT[O pN THIS SPACE)THIS IS YOUR PERh11T <br /> °�� <br /> T� <br /> [�� <br /> � <br /> �� <br />