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the Euergreen <br />CITY OF <br />eVe�et� <br />259-8745 <br />C"�IV�TR4JCTIDRI <br />P�RMI�' <br />PERMIT NO. � U U 5 U <br />❑ DEMOLI710N I� COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER R1411 ApDRESS CITY 21P PMONE <br />Melum & Smith P.O. Box 592 Lk Stevens, WF. 98258 653-2025 <br />ARCHITEGTOfiDES�GNER MAILA�OP[SS CItY ZIF PHONE <br />GENEltALCONTMC:JR hINIADDRESS CiTY [IP PHONE LICENSEa <br />Same h7ELUhf180P7 <br />MECHANIClLCONTPACTON AtNLAD�RfSS Cltt LP VHONE LICENSEa <br />PLUMBINGCONTRACTOR Idf.iL�O�P[5; QTY ZIP P��ONE LIC[NSE• <br />ClASS OF WORN <br />�N[W ❑ ADDI710N <br />VALUATION OF 1YORK <br />5 40,500.00 <br />❑ ALTERATION ❑ f1EPAIR ❑ DEMOLITION ❑ EUILDING RELOCATION <br />New Sinqle family residence - basic #1120 <br />MEAT SOUi10E <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PqOFUSE0l15E OF �UILDING <br />Sinqle Family Residence <br />ior.13_ u�acK _ <br />PLUMBING <br />NO. <br />T�PE OF C <br />V-N <br />OF FIXTURE OR ITEM <br />WATER CLOSET �TOILET� <br />BATHTUB <br />LAV470FV (VJASH BASIN� <br />SHOwEfi <br />KITCHEN SINK & DISP. <br />DISMWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRWr:ING FUUNTAIN <br />FL007 ORAIN <br />OACKFLOW PREVENTER$ <br />ROOF DRAINS -- RAINLEACERS <br />SINN �SERVICE — BAR. ETC.) <br />SUBTOTAL <br />PEflM1T <br />TOTALfEE <br />�O <br />�OT AREA <br />%�� <br />OCCUPANCY GflOIIP <br />R- 3 <br />1120+480GARI 1 <br />nrvucnnoNncc er <br />AI.M. <br />r�nr�s criEr,neo [�v <br />R.E <br />rour+coaiesi <br />I HEREBY CERTIFY THAT I HAVE R[AD AND EXAMINED THIS <br />APPLICATION AND KNO\N THE SAME TO BF TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK Wll_L BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR fJO�. THE GRANTING OF A <br />PEfi�AIT DOFS NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHEfl <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION O�i <br />THE PERFORM.4NCE OF CONSTRUCTION. <br />SIGN4Tl1 [ OP COrvTMCiOP. AUTIIOFIZEO AGENT.OR O'�.NEP DilTE <br />/ J / � /� <br />X �-� ,�. .�����„ �./y� ,�s � <br />_ , <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A�C — n/HN�LG UNITS — H P. <br />REFRIGERATION UNITS — HP. EA. <br />BOILEFS — BS.0 MP. <br />GASFIREDAC UNITS—BS.0 <br />FORCED AIR SVSTEh15 — BS.0 td EA. <br />WALL HEATERS — B T.U. M <br />UNIT HEA7ERS — � T.0 M <br />EVAPOMTIVE COOLERS <br />CLOTHES7RYERS <br />2 VENTILATION FAN <br />1 R�NGEHOOD <br />1 VlATER HEATER <br />WOODSTOVE <br />A7E1AL PIFEPLACF_ 8 CHIPd � <br />FIRFPLACEINSEFiT T— <br />H[AT PUb1P •- <br />GAS PIPING '� <br />EXHAUSTFAN � <br />��im <br />�-■ <br />O�m <br />VECANT SITE <br />}6[S ❑NO <br />NO OF DWELLING UNIiS <br />1 <br />n�nx oCC lon� <br />N/A <br />APPf1 fOli ISSUFNCE [3" <br />L. C. <br />PLAN CHECR NUIdBER <br />87/18858 <br />FEES <br />BUILDING <br />PLULIBING <br />MECHANICAL <br />INVESTIGATION FEE <br />5UB iiYiiiLV JO l L <br />PER • <br />TOT� <br />F <br />PLE� 31. � <br />101 <br />� 4�'�d�y5 0 � <br />l <br />i <br />Sec.304(e) <br />FEE <br />ifi6EIPT NO. <br />.00 g0357 <br />�� <br />.OD <br />FEE <br />STATE BUILDING SURCHARGE <br />STAT2 ENEf7GY SUiii,liui� <br />DRIVEWAV PERMIT <br />TOTAL <br />PERMIT VALIDAl70N <br />WHEfJ PROPB(iLV V�LIO�TED (IN TI IIS $�'ACE� TIIiS IS YpUR PL(ih9T <br />0 <br />'. � • � <br />�! <br />• <br />♦� <br />� <br />