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11 <br />the Evergreen <br />CITY OF <br />leverett <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />CONSTRUCTION <br />PERMIT <br />❑ COMBINATION E BUILDING ❑ MECHANICAL <br />PERMIT NO. 08634 <br />❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Lorene C. Bennett 7808 Beverly Blvd. 98203 355-7772 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />Same <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE E <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CLASS OF WORK <br />❑NEW %XADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />E 9,000.00 <br />DESCRIBE WORK <br />addition to existing residence <br />PROPOSED USE OF BUILDING <br />single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AFC <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN URF�OF _NT 'OR OR AUTHORIZED AGENT DATE <br />X ? /M.c <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR CORES) <br />6-7 7 Beverly Park <br />LOT BLOCK -Of <br />JOB ALUM!,!, <br />7808 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(TOILET) <br />AIR COND. UNITS - H.P. EA <br />_ <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA <br />LAVATORY ASH BASIN. <br />BOILERS - H.P. EA <br />GAS FIRED A.C. UNITS - TONNAGE EA. <br />SHOWER <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.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 UNII - C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK SERVICE - BAR. ETC.) <br />SUB TOTILL <br />SUB TOTAL S <br />PERMIT <br />i <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />6E <br />STREET SETBACK <br />201 <br />REAR YARD SETBACK <br />201 <br />PLAN CHECK NUMBER <br />80/8634 <br />PLAN CHECK <br />FEE 48.43 <br />FEE <br />RECEIPT NO. <br />51427 <br />USE ZONE <br />R-1 <br />LOT AREA <br />VACANT SITE <br />OYES HOP <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />V-N <br />OCCUPANCY GROUP <br />R-3 <br />NO. OF DWELLING UNITS <br />1 <br />BUILDING <br />S 9,000. <br />74 <br />50 <br />SIZE OF BLDG. <br />i T x24 E &6 T X8 E <br />NC OF STORIES <br />dd 1 <br />MAX, 000. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />none <br />FIRE <br />REQUIRED <br />BYESUIV <br />SPRINKLERS <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />_ <br />PENALTY <br />U.B.C. <br />SEC. 3D3 (a) <br />2. BUILDING PLANS <br />TOTAL <br />74 <br />50 <br />3. FIRE HYDRAivT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WIiFN PROPERLY VALIDATED IIN THIS WE) THIS Is YOUR RPER PERMIT <br />II [( SDP -- <br />CD <br />, ) I` R E L ` `` I I T <br />5. GRADING <br />0 DRAINAGE <br />— <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />B <br />APPLICATION ACC Y <br />PLANS CHECKED BY <br />V.C. <br />APPR. FOR ISSUANCE 0Y <br />