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rhn FrA10rEE^ APPLICATION FOk EYPTEN <br />CITY or CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT <br />259-8745 ❑ <br />COMBINATION ® <br />BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNEn <br />Boyden Realty, Inc. <br />MAIL AODIUSS <br />1429 Broadway <br />CITY <br />Everett <br />ZIP <br />98201 <br />PIWNE <br />252-1166 <br />AnCIII T ECI On DESIGNER <br />Cary Parkinson <br />MAIL ADODEiD of" <br />527 Medical Dental Bldg. Everett <br />TIP <br />98201 <br />PHONE <br />252-2153 <br />GEIIF DAL CONMACTOn <br />J 6 D Builders <br />MAIL ADO""$ <br />11129 Broadway <br />OITY <br />Everett <br />ZIP <br />98201 <br />PHONE LICENSE• <br />252-1166 223-01 <br />IALCIIANICAL CONTRACTOR <br />MAIL ADOGESS <br />CITY <br />ZIP <br />PHONE LICENSE E <br />JDBU1223JO <br />PLAMBRIO CONTRACTOR <br />White Coast Plumbing <br />MAIL ADDRESS <br />1.19 Avenue A <br />CITY <br />Snohomish <br />EIP <br />98290' <br />PHONE LICENSEE <br />568-6155 <br />CI A15 OF WORK <br />9 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT <br />❑ BUILDING RELOCATION <br />IAL UALION OF WORK ICOST or MAIEnIALA PLUS LANOm <br />DESCRInE WOnK /� <br />NEw Single Family Residence - Plan <br />USE C: BUILDING <br />SFR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL RE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. 711E GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONIn CIOn On AUTIl0 LED AGENT DATE <br />x ����i�'y_y <br />APPLICANTS CITY BUSINESS LICE N5E NO V <br />LEGAL OE56nIP1ION OF P1oFERTY1SNOWN BELOW ORATTACII FOUR CONED <br />65 Sunridge Div. III <br />LOI_BLOCIr__oF <br />131 - 93rd St., S.C., Everett <br />PROJECT ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />_ <br />LAVATORY WASH BASIM <br />BOILERS- I.P. EA <br />SHOWER <br />OAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK • DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDAYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS _ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />RANGE 14000 <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEAVERS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE -BAR ETC.) <br />WOOOSTOVE FIREPLACE INSERT <br />BUD TOTAL <br />BUB TOTAL • <br />PERMIT IT <br />PERMIT • <br />TOTAL FEE t <br />____ TOTAL FEE • <br />OF CONST <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />n SETBACK SIDE SETBACK PLAN OIECK NUARS, MAN CHECK FEE <br />M//(*/57 34""" FEE nECEIPE NO <br />AOEA VACANE SIZE <br />OVER LINO /![S VALUATION All <br />OCC LOAD <br />FOR ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />