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u,B e,>pT BAF, Co- F <br /> CITY OF C INSTRUCTION <br /> ev <br /> - - 18345 34 C <br /> 259 -8745 PERMIT NQ:: <br /> ❑ <br /> DEMOLITION ❑ COMBINATION ❑ BUILDING ® MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAIL ADDRESS CITY IIP ATONE <br /> David E. Smith 104 79th P1 SE Everett, WA 90203 353-6430 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP ATONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY IIP PHONE LICENSEE <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY IIP PHONE LICENSEE <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY IIP PHONE LICENSEE <br /> CLASS OF WORK <br /> ❑ NEW ❑ ADDITION ❑ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br /> VALUATION OF WORK <br /> f 1200.00 <br /> DESCRIBE WORK <br /> Fire place insert installation <br /> HEAT SOURCE <br /> ❑ ELECTRICITY ❑ OAS ❑ WOODSTOVE ❑ OTHER <br /> PROPOSED USE OF BUILDING <br /> Single family residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> LEGAL DESCRIPTION OF PROPERTY(SHOW BELOW OR ATTACH FOUR APPLICATION AND KNOW THE SAME TO BE TRUE ANDRCOPIESI CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> LOT_BLOCK _OF 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 /> TPERFORMANCE OF CONSTRUCTION. <br /> JOB ADDRESS CIRE OF CONTRACTO U I IZED ENT,OR OWNER DATE <br /> 104 - 79th Pl SE to <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC-A1HNDLG UNITS-H P <br /> BATHTUB REFRIGERATION UNITS-H P.EA. <br /> LAVATORY(WASH BASIN) BOILERS-B.T.U.M R <br /> SHOWER GAS FIRED A C.UNITS-8 T <br /> KITCHEN SINK S DISP. FORCED AIR SYSTEMS-8 T MEA <br /> DISHWASHER WALL HEATERS-BTU. M <br /> LAUNDRY TRAY UNIT HEATERS-B T U M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAL CLOTHES DRYERS <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR DRAIN RANGE HOOD <br /> BACKFLOW PREVENTERS WATER HEATER <br /> ROOF DRAINS-RAINLEADERS 3 WOOD STOVE <br /> SINK(SERVICE-BAR.ETC) METAL FIREPLACE S CHIMNEY <br /> FIREPLACE INSERT 30 00 <br /> HEAT PUMP <br /> OAS PIPING <br /> EXHAUST FAN <br /> SUB TOTAL f SUB TOTAL 30 00 <br /> PERMIT f PERMIT <br /> TOTAL FEE S. TOTAL FEE 30 OO <br /> FRONT SETBACA REARSETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO <br /> USE ZONE LOT AREA <br /> VACANT SITE FEES VALUATION FEE <br /> []YES ❑NO <br /> TYPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS BUILDING S <br /> PLUMBING <br /> SIZE OF BLDG NO OF STORIES MAX OCC LOAD <br /> MECHANICAL 30 0 <br /> INVESTIGATION FEE U ,'wL/.6q*:D -AM 000459t. <br /> IRE SPRINKLERS FIOUIRED 0 YES 11 NO <br /> STATE BUILDING SURCHARGE 1100010745 <br /> STATE ENERGY SURCHARGE MLLI4 .OU <br /> APPLICATION ACC BY PLANS CHECKED BY APPR FOR ISSUANCE BY <br /> DRIVEWAY PERMIT <br /> M.M. TOTAL 30 0 <br /> PERMIT VALIDATION <br /> WHEN PROPERLY VALIDATED BN THIS SPACE)THIS IS YOUR PERMIT <br /> L0 <br /> 00 <br /> ADDRESS fit E <br />