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r A CITY OF EVERETT <br /> r,,. . CONSTRUCTION <br /> I <br /> 0259-8810 <br /> PERMIT PERMIT NO. 21553 <br /> [] DEMOLITION 0 COMBINATION 0 BUILDING U MECHANICAL 0 PLUMBING 0 SIGN <br /> OWNER MAILADDRESS UTY bP PHONE <br /> Marvin A. Laborn 14 - 76th St 99 Everett 98023 355-1709 ' <br /> TENANT MAILADDRESS CITY ZIP PHONE ' <br /> ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br /> CENERALCONTRACTOR MAILADDRESS CITY SIP PHONE LICENSE <br /> Owner <br /> MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br /> N C1H <br /> PLUMBING CONTNACTOR MAILADDRESS CITY 21P PHONE LICENSE• <br /> ' ay <br /> oxx - <br /> 9 H CUSS OF MAX <br /> H(A 0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 DEMOLITION 0 BUILDING RELOCATION <br /> frl CONTACT PERSONANDPPONE NO.IF OTHER THAN ABOVE <br /> K p CONTRACT PRICE OF WORK: $ 1100 <br /> O "r 0 DESCRIBE WORX AND SOUARE FOOIAUE INVOLVED <br /> "IV Reroof <br /> t1 O <br /> HC7 r"oPoseD usEaeuILDING <br /> ~ SFR <br /> ~ �� LEDALDESCRIPIXNOFPROPERTYISI iSEL01VORATTACHFUJRCOPIESI <br /> l01_BLIXIA_OF <br /> > H R 08/16/91 11:261111 DODANS454 ttfl <br /> t - H / <br /> g [Al H 000027553 <br /> w Tv 4,2_00 <br /> - <br /> 8/. 8 SRCH $4.50 <br /> tt, 14 - 76th St J3W S t <br /> H O En PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC-A:HNOLG UNITS-H P <br /> BATHTUB FORCED AIR SYSTEMS-B TU M EA. <br /> —� <br /> LAVATORY(WASH BASIN) UNIT HEATERS-BTU M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> T� DISHWASHER RANGE HOOD <br /> 'elft AW LALPNDRY TRAY WATEII HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE A CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS OAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR.ETC) <br /> SUBTOTAL t SUBTOTAL t <br /> JZ PERMIT t PERMIT EI <br /> TOTAL FEE f TOTAL FEE II <br /> ' INONT SETBACK REARSEIBACK SIDE SEIIACK ',PICHECKNUMBER FEE HEGEIPT NO <br /> A' <br /> ,.IE ZONE LOT AREA VACANT SITE <br /> FEES DII��1 FEE <br /> ❑TBS ❑NO <br /> '•PEOFOOSTRIICTONULOWABE TYPE OFOXISIRUCT10NACIDAI wP� IJIOCr.�.. '. -RING $ 1.100 27 0 <br /> VmNG <br /> ,iZE OF FLOC NO OF STORIES BASEMENT - <br /> nANICAL <br /> ❑vE5 ❑NO <br /> OCCUPANCY LOAD TIME SPRINXLCnS"COO HEIGHT LIMIT n1 Ir N <br /> [I YES ONO _ <br /> REASON Fo"SrnPIxlCHS I TYPE BUILDING SURCHARGE 4 30 <br /> STATE ENERGY SURCHARGE <br /> APPLK:ATENACC BY PUNSAPPROVLDRY CITY OF EVERETT <br /> LOCAL SALES PUBLIC wonKs <br /> TAX CODE IS TOTAL !1 0 <br /> 3105 <br /> WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT <br /> PERMITS EXPIRE IF WORK IS NOT COMMENCED WITHIN 27553 <br /> 180 DAYS OR CEASES FOR MORE THAN 180 DAYS. AIWJAFGS FII F <br />