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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 <br />;ONSTRUCTION <br />PERMIT <br />❑ COMBINATION ❑ BUILDING %x MECHANICAL <br />PERMIT NO. 14218 <br />PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />0. W. Stillwell 7806 Beverly Blvd. Everett 98203 355-5052 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY - ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Same <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN TQ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />f <br />Install hearth heater <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. 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 VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRAC OR OR AUTH RIZED AGENT DATE <br />XQ ��'- ./5/84 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT —BLOCK —OF <br />JOB ADDRESS <br />7806 Beverly Blvd. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TO!LET) <br />AIR COND. UNITS — H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS — M.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />_ <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — S.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE — WOOD <br />50 <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE a CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL s <br />SUB TOT-. f <br />7 <br />50 <br />PERMIT f <br />PERMIT f <br />0 <br />00 <br />TOTAL FEE f <br />TOTAL FEE S 1 <br />17 <br />50 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK. NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILD!HG <br />f <br />SIZE OF SLOG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />FLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES NO <br />MECHANICAL <br />17 <br />50 <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PL.NALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />171 <br />50 <br />3. FIRE HYDRANT <br />A. FIRE PROTECTION SYSTEM <br />P-_RN11T VALIDATION <br />WHEN PHOPERL'( VALIDATED (IN THIS SPACE) THI$ ISPERMIT <br />�[ i 9 �PD O I <br />N <br />. J2 R:: C E I PT 'L" <br />U <br />S. GRADING <br />8. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE - ``'J 8.11 <br />