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theLbergreen �" � �NSTRUGTION - � � <br />GTY OF <br />everett PERMIT PERMIT NO. _ � � �"'�, �- <br />259 -SF310 <br />O DEMOLITION ❑ COMBINATION ❑ BUILpING ❑ MECHANICAL L PLUMBING ❑ SIGY <br />O�VNE�i G:SIL 1D�PE55 CITV ZiP PIIONL <br />I�onard &;aula Kooistra 109].4 9th Dr.. S� Cverett, 9R201 355-1029 <br />TENANT A1All AppRE55 CITY ZIP r'i�PNE <br />A!{CMITECTOflOESIGNER MAILADDR[SS CITY ZIP PHONE <br />G[NERALCONTRFCTOq MAILADDfiESS CIT� ZiP PMONE UCENSEn <br />MECHANICALCONTR�CTOF MAILAD�FESS pTY ZIP PHONE UCENSEd <br />PLUMpINGCONTRALTOR MAILAD�RESS CITY ZIP PHONE UCEI:_Eu <br />CLASS OF WORH I' <br />❑ NEVI ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION O BUILDING flELOCATION � <br />I CONTACT PERSON ANp PHONe NO. IF OT4ER THqN ADOVE <br />CONTF4CT PRICE OF WORK: S <br />WOf1N ANO SOUl+fiE FOOiA4E INVOLVE� <br />eplace insert <br />PROPOSEO USE OF Bt11LDING <br />SFR <br />LEGAL OESCRIPTION OF PROPERTV �SMO\V BELOYJ OR ATTACH FOUR COPIES) <br />LOT_ BLOCK_ OF <br />JOB ADDliE55 <br />10914 9th Dr. SG <br />PLUMBING <br />NO. TYPE OF FI%TURE 0 <br />WATER CLOSET �TOILET) <br />BATHTUB <br />LAVFTORY�WASHBASIN) <br />SNOWER <br />KITC4EN SINK 8 DISa. <br />�ISHN'ASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINXING FOUNTAIN <br />FLOOR GRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEAOCRS <br />SINK (SERVICE— BAR, ETC.) <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT <br />A/C — ArHNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — 8 T.U. M EA. <br />UNITHEATEflS—B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />INATEF HEATER � '+ <br />VlOCD STOVE <br />METAL FIREPLACE 8 rHIMN� ^jG.SB <br />], FIREPLACE INSERT �'jECN <br />HEATPUMP CHECK <br />GAS PIPING <br />EXHAUSTFAN <br />� SUBTOTAL S — — SUBTOTAL <br />PEHMIT S PERMIT <br />TOTALFEE S �L TOTALFEE <br />vFOr�rsE'f3ncK qEnRSETOACK SioEs[TonCrc P�ANCHECKNUMBER PEE <br />USEZONE IOTAREA VNCANT9TE BUILO <br />❑ YES ❑ NO FEES yp i <br />rvr�aFcor�su�ur.imrvniio:vr.n�e nr[ovcr,usraucna�nciur.i ,.,,,,,,=� sonvo;•;ewr:cu�:us gui�oiNG 5 <br />PLUMBING <br />9ZEOFOIDG NOOfSTONES �ASElAENT <br />❑ vES ❑ NO MECHANICAL <br />OCWPANCYtOAD fIqESPRINKLERSFEOD HEIGHTUldIT4T10N OTHER <br />❑ YES ❑ NO — <br />nensor� Fon;cewK�ens STATE �UILDING SURCHARGE <br />S7ATEENERGYSURCHARGE <br />nv�iicnrioNnr.c �+r r��nv;nvvnovenov CITY OF EVERETT <br />LOCAL SALES PUOLIC WORKS <br />TAX CODE IS rora� <br />3105 ___ <br />PERMITS EXFIRE IF WORK IS NOT COMMEN�:ED WITIiiN <br />dUDHC:SSIIL'c <br />180 DAYS OR CEASES FOR MORE THAh 180 �AYS. <br />FEE <br />30 I 00 <br />5 30` -00 <br />5 <br />5 �0 00 <br />RECEIP7 NO <br />FEE <br />Tfii� IS YOUf2 PERMIT <br />