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IIICC'VBlgI'C'fR <br />CITY OF <br />everett <br />259-8?45 <br />� �N�T��. ���N <br />R�RMIT <br />�'."�';'�1::� <br />PERMIT NO. - � U � r � <br />� DEMOLITION [� COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEP M1IAILAODRE55 CITY ZIP PHONE <br />Me1um & Smith P.O. Bor. 592 Lk Stevens 98258 653-2025 <br />PRCMRECTOfipE51GN[R h1AILADDRESS CITY ZIP VHON[ <br />GEYERALWNTIi�CTOB MNLAD�PE55 CRY 21P PHON[ LiCENSEu <br />O+mer MELUh1180P7 <br />MECHANICALCONTliACTOR M�ILA�pf1EtiS QTY ZIP PIIpNE LICENSEu <br />PLUMPdIG CONTRqCTOR h1AiL FD�RE55 CItY ZiP PHONE IICENFE � <br />CLASI.OF N'Of1K <br />�N°W ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDIi.G RELOCATION <br />vswnnc� or c:onK <br />5 44,500.00 <br />OESCFIIBE WOFlK <br />Single family residence Basic 1244 <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />Sinqle family residence <br />�EGAL <br />ior 16 o�ocK — or �rson Pl. <br />JODFO�FE55 <br />10911 9th Dr. SE <br />PLUMBING <br />N�— TYPE OF FI%7URE OR ITEM <br />YJATEfl CLOSET �TOILET� <br />BATIiTUB <br />LAVATORV�WASH BASIN� <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUN�RYTRAV <br />CLOTHES WASHER <br />URINAL <br />�RIIJKING FOUNTAIN <br />FLOOfl �RAIN <br />OAC:<FLOW PREVENTEPS <br />ROCF DRAINS — RAINLEADERS <br />SINK (SERVICE — �AR. ETC.� <br />2 <br />20 <br />USEZONE <br />R3f$ R-1 <br />TYPE OG CONST. <br />V-N <br />SIZE OF F1LDli <br />1264+480 G1�R <br />FIRE SPPINKLEPS RE( <br />nr�r�ucnnouncc ov <br />S.H. <br />SUBTOTAL 5 <br />PEqM1T 5 <br />TOTALFEE 5 <br />2� <br />LOT ApEA <br />DCCUPANGVGROUf <br />R-3 <br />NO OF SiON[5 <br />1 <br />� ❑ VES {�7 NO <br />r�nnis cr+ecKen ov <br />B.E. <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION 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 HEREIN OR NOT. THE GRANiING OF A <br />PERMIT DOES NOT PRESUME TO (31VE AUTHOHITY TO <br />VIOLATE OR CANCEI TNE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SiGN;.TUpE O� CONTPFGTOR, AUTHORIZE[1 �GENT.OR OWNER DATE <br />X/'��.._ . <br />MECHANICAL <br />IJT— TYPE OF EQUIPMENT <br />A: C— A/HNOLG UNITS -- H P <br />REFPIGERATION UNItS — H P. EA. <br />BOILERS — 57L �N P <br />GAS FIREO AC UNI7S — �7 U. <br />FORCED AIR SVSTEMS — � T.U. M EA. <br />WALL HEATERS -- BS.U. M <br />UNIT HEAT[RS — B T.0 M <br />EVAPOR�TIVE COOLERS <br />CLOTHES Of1VERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER � '- ' <br />6VOOD STOVE <br />MEiAL FIREPLACE S CHIA1N � � <br />FIREPIACEINSERT <br />HEAT PUMP <br />13A5 PIPING <br />E%NAUSTFAN �- <br />1 <br />1 <br />SUB <br />PEfl <br />TOT <br />f3nCK PLAN CHECK NUM�ER I <br />6 87/28860 <br />'�'E FEES <br />❑ r+o <br />iaciiwr.iiurtc BUILDING <br />1 <br />6��Y OCC LO�D <br />N/A <br />APPq pOB ItiSUA!!CE f1Y <br />B.E. <br />PWMBING <br />MECHANICAL <br />INVESTIGATION FEE <br />FEE <br />wu�uo++u RECEIPT NO. <br />F •� �'0.00 <br />ION FEE <br />' 4.00 <br />45 <br />28 <br />SeC.304�c� <br />STA7E DUILDING SURCHARGE <br />STATEENEHGVSURCHARGE <br />DRNEWAV PERMIT� <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLV VAIIUATED (M TIiISSPACEI T��I515 YOl1R P[RiA11T <br />