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Me A1FFv <br />CIrn CO NSTR U CTI O N <br />ev PERMIT PERMITNQ:- 17513 <br />259-8745 <br />-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 11 MECHANICAL ❑ PLUMBING ❑ SIGN <br />GiOWARD MADISON 1411 _MAIL <br />AR9SNXSX 73rd St. SW DT. Everett WAzIP 98203 355-ONE <br />7368 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />DENE?,L mOeNTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE I <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/ <br />)p NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />S <br />Install fireplace insert <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS Cl WOODSTOVE ❑ OTHER <br />PROPOSED USE OF RUILDING <br />Residence <br />I HEREBY CERTIFY THAT I HAVF READ AND EXAMINED THIS <br />APPLICATION AND KNOW THIS 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 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 DATE <br />J( <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH FOUR COMES) <br />LOT — BLOCK _— OF <br />JOB ADDRESS <br />1411 - 73rd St F <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS - <br />BATHTUB <br />REFRIGERATION UNITS - <br />LAVATORY ( WASH BASIN) <br />BOILERS - B.T.U./H P. <br />SHOWER <br />GAS FIRED A-C. UNITS - B. <br />KITCHEN S•NK { DISP. <br />FORCED AIR SYSTEMS - B M EA. <br />DISHWASHER <br />WALL HEATERS -B T.U. l M <br />LAUNDRYTRAV <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COM <br />7RINAL <br />S DRYER <br />DRINKING FOUNTAIN <br />TION FA <br />FLOOR DRAIN <br />HOOD <br />BACKFLOW PREVENTERS <br />HEATER <br />ROOF DRAINS - RAINLEADERS <br />TOVE <br />SINK (SERVICE - BAR. ETC.) <br />IREPLAC <br />CE INSERMPINGTFAN <br />IFA <br />SUBTOTAL <br />{ <br />PERMIT <br />{ <br />TOTAL FEE <br />{ <br />FRONTSETRACK <br />REAR SETBACK <br />BIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT Nn <br />USEZONE <br />LOT AREA <br />VACANTSITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />PLUMBING <br />SIZE OF DIDG <br />NO OF STORIES <br />MAN OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />Sec. 3D4(e) <br />Q <br />APPLIGTION ALC BY PLANS CHECKED BY APPR FOR ISSUANCE Dv <br />STAIE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />DRIVEWAY PERMIT <br />TOTAL <br />30 <br />WNEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PFRMIT <br />M <br />Lo <br />N <br />A1� <br />ADDRFSS rlt E <br />