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fhe Evergreen <br />CITY OF <br />everett <br />259 - �3745 <br />�'aIVSTRUCTIOIV <br />I�ERMIT <br />PERMIT NO: I � � U � <br />❑ DEMOLITION ❑ COMBINATION Q BUILDING ❑ MECHANICAL �[� PLUMBING ❑ SIGN <br />owrven n+nii noaacss arv zir rrwr�e <br />S.C. Kniqhtall 30�0 16th St. L•berett, S9A 98201 252-7734 <br />APCHIT[CT OR pE51GNtR R1�IL �OOP[55 CRY ZIP eMONE <br />GENEFALCONTRALTOit 1,1qIt4DDRE55 Qiv ZIP PIIONE LiG[NSEv <br />owner <br />MECIIANICFLCONTfiFCTOR MAILAOORE55 CITY ZIP I'HONE LICENSEa <br />PLUMDINGCONifUCTOR MFILAD�tiE55 CITY 21P PHONE LICENSEn <br />ClASS OF 'NORK <br />�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />VALUATION OF WORR <br />g 1%�Q.�� <br />OESCRIOE lYOFK <br />Deck <br />MEAT$OURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE <br />L[G�L <br />�or _ ni.ccK �_7 <br />PLUMBING <br />NO. TYPE OF FIXTURE C <br />WATEH CLOSET (TOILET� <br />BATHTUB <br />LAVATORV�WASHRASIN� <br />SHOINER <br />KITCHEN SINK 6 DISP. <br />DISIiWASHER <br />LAUNDRVTRAV <br />CLOTHES VJASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADEPS <br />SINK (SERVICE — BAfl, ETC.) <br />io <br />USEZONE <br />R-2 <br />TYPE OF CONST <br />}L� V—N <br />SIZF OF f3LD[ <br />168 <br />FIRE SPRINKLERS F <br />APPLIC�TION�CC fiV <br />hf . M. <br />Sl1B TOTAL <br />PEHMIT <br />TOTALFEE <br />REAR SETHFCM <br />zo <br />�oi:nEn <br />9095 <br />OCGJPnNCVGROL <br />M-1 <br />NO JFSTORi[5 <br />1 <br />_O VES C�NO <br />P14N5 CNECKED [1' <br />B.E. <br />FEE <br />s <br />vnc4Nr 51rE <br />_l res C�o <br />NO OF DWELLING UNIiS <br />0 <br />N/A <br />APPR FOR ISSl1r1NCE OV <br />� <br />❑ DEMOLITION <br />❑ OTHER <br />❑ BUILDING RELOCATION <br />� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 6E 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 GRANTING OF A <br />PERMIT DOES NOT PqESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THG PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR�F C�(J�JTPp�)fl!AUT��OR�§f�iflPl�f�TJWNER DATE <br />4 <br />NO. TYPE OF E�UIPMENT <br />AiC — A'NNDLG UNITS — H P. <br />FiEFRIGE(7ATION UNITS — H P. EA. <br />�OILERS — BS.U./HP. <br />GAS FIRED A�C. UNITS — � T.U. <br />FORCE� AIF SVSTEMS — BS.U. M EA <br />WALL HEATERS — B.TL. W <br />UNIT HEATERS — p T.U. M <br />EVA�ORAI'IVECOOLERS <br />CLOTHESDRYEPS <br />VENTILATION FAN <br />RANGEHOOD <br />VJATER HEATER • <br />WOODSTOVE <br />McTAL FIREPLACE 8 CHIMNSY <br />FlREPLACE MSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHECK NUMBER <br />88/].9763 <br />FEES <br />6UILDING <br />PLUM9ING <br />MECHANICAL <br />INVESTIGATION FEE <br />FEE <br />SUBTOTAI 5 <br />PENMIT S <br />TOTALFEE <br />FEE FIECEIPT NO. <br />9.75 95453 <br />VALUATION FEE <br />S <br />I <br />I <br />See.304(c) I <br />STATE BUILDING SURCHARG <br />STATEENERGVSURCHARGE <br />DRIVEWAV PERMIT <br />�� <br />TOTAL I I q2 <br />PEHMIT VALIDATION <br />Wf I[N PROPERLY Vnl.IUnTLD (IN T11IS SPnCG� THIS IS vOUR PERM11IT <br />