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tAE EYerpreen <br />CITY OF <br />everett <br />BUILDING DEPT. <br />259.8745 <br />kePLICATION FOK- <br />CONSTRUCTION <br />PERMIT <br />10 BE COMPLETED IN BLACK INK— PLEASE PRINI <br />❑ COMBINATION ® BUILDING ❑ MFCHANICAL <br />ri <br />❑ PLUMBINO 0 SIGN <br />OWNER <br />MAIL AOOnt SS <br />CITY <br />EIP <br />PIIOIIE <br />- <br />Boyden Realty, Inc. <br />1429 Broadway <br />Everett <br />98201 <br />252-1166 <br />AnC.1I orC Ian DEII.InnR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />- <br />Gary Parkinson <br />527 Medical Dental. <br />Bldg. Everett <br />98201 <br />252-2153 <br />GENERAL CONTRACTOR <br />MAIL AnOnf/E <br />CITY <br />HP <br />PHONE <br />LICENSE• <br />i 6 D Builders <br />1429 Broadway <br />Everett <br />98201 <br />252-1166 <br />223-01 <br />MECNANICAL CONTRACTOR <br />MAIL AOURESS <br />CITY <br />ZIP <br />P110NE <br />LICENSE F <br />3DBUI223JO <br />PLUMBIIIO CNTTnAgtCR <br />MAIL APDRf SS <br />CITY <br />TIP <br />PHONE <br />LICENSE• <br />White Coast Plumbing <br />119 Avenue A <br />Snohomish <br />98290 <br />568-6155 <br />9 NEW ❑ ADDITION ❑ ALTERATION ❑ RFPAIH ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION 01 WORKICOBI OF MATERIALS PLUS LABOM <br />CESc TnOE WOnK ' <br />New Single Family Res.dence - Flan (� <br />USF Or SUIT VINO <br />SFR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRF:CT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL RE COMPLETED WITH WHETHER SPF.OIFIEDHERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURnt OF fONTn TOROR THO EO AGENT ,DATE,/3/" <br />X /(/��(�!1 1 ee, a,. <br />LEGAL DECCONtION OF PNOPEOT Y IBnOWN BELOW OR ATTACH FOUR COMES <br />57 Sunridge Div. III <br />1.G1—BLOCK—or_ <br />212 - 93rd St., S.E., Everett <br />PROTECT ADDRESS <br />APPLICANrSCITY BUSINESS LICENSE NOV <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSETITOILETI <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />RErRIOERAt10N UNITS—H.P. EA <br />LAVATORY IWASII BASTM <br />BOILERS—ILP. EA <br />_ <br />SIIOWER <br />OAS FIRED A.C. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK• DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASIIER <br />_ <br />WALL HEATERS—B.T.U. <br />LA1JNDnY1nAY <br />_M <br />UNIT IIEATERB—B.T.V. M <br />CLOTHES WASIIER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ _ <br />_ <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS_ <br />_ <br />ROOF DRAINS—RAINLEAOEns <br />_STOVE <br />METAL FIREPLACE S CHIMNEY <br />SINKISERVICE—BAR. ETC.I <br />WCOOSTOVE/FIREPLACE INSERT _ <br />SUB TOTAL <br />BUB TOTAL • <br />PERMIT E <br />PERMIT_ • <br />TOTAL FEE • <br />TOTALFEE • <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />CHECK NUMBEn <br />8p <br />VACANT THIS I rBE• <br />r1YI a ONo <br />TYPE or cons, <br />OCCIIP IICYGII p <br />NO OF DWELLING UNITS <br />BUILDING <br />SIZE OI SLOG <br />Ito UT STORIES <br />MAX MC LOAD <br />PLUMBING <br />FIRE' PRINKLERS nEOUIRCD DYES D OTI <br />MECHANICAL <br />OILIER <br />PENALTY <br />F PLICAIIONACC BY <br />MANS CIIECKEO BY <br />9 <br />APPR FOR ISSUANCE BY <br />TOTAL <br />FEE .L1-__ <br />VALUATION <br />RECEIPT NO. <br />FEE <br />