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the Fvergreen <br />CITOF <br />everett C INSTRUCTION <br />PERMIT PERMIT NO. 19046 <br />J � <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ® MECHANICAL ❑ PLUMBING ❑ <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />William & Nancy Rossman 632 Wetmore Ave EvereLL, WA 9a20l 252-1309 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE_— <br />ADDRESS <br />ZIP <br />------••-••-••••^�•�^ MAIL AuuHCJ5 CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK <br />Existing fireplace insert <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />duplex <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT 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 />SIGNATURE OF CONTRACTOR. AUTHORIZED AGENT, OR OWNER RATF <br />X 7— 10/27/87 <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATi ACH FOUR COPIES) <br />LOT — BLOCK _ OF <br />JOB ADDRESS <br />1909 16th Street <br />PLUMBING <br />MECHANIC <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H.P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />3 <br />_ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />$ <br />SUB TOTAL <br />_ <br />PERMIT <br />$ <br />PERMIT <br />TOTALFEE <br />$ <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCCLOAD <br />MECHANICAL <br />30 <br />00 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />Sec. W4(e) <br />_ <br />S FATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />S M.M. <br />PLANS CHECKED By <br />APPq. FOR ISSUANCE <br />BY <br />DRIVEWAY PERMIT <br />TOTAL <br />30 <br />OO <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />C0 <br />Ct' <br />t— <br />ADDRESS FILL <br />