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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />CINSTRUCTIC+N <br />PERMIT <br />❑ COMBINATION UBUILDING L-1 MECHANICAL <br />PERMIT NO. 09690 <br />Ll PLUMBING <br />OWNER MAIL ADDRESS nr ZW PHONL <br />Paul Murker 8014 Beverly Blvd. 353-4403 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE D <br />H 8 G Glass Co. <br />2931 Bond Street <br />Everett <br />98201 <br />353-8484 <br />M!CHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP HG <br />CL irl04PE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑NEW ❑ADDITION ❑ALTERATION [R*PAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />E 1400.00 <br />aii�v.�a cawily - <br />PROPOSED USE OF BUILDING <br />Re -roof --Composition <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <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 />SIGNAT OF CO RACTORO THORIZE AGENT DATE <br />X 8 24 81 <br />LEGAL DESCRIPTION OF PROPER" (SHOW BELOW OR ATTACH FOUR COPIES) <br />27 5 Beverly Park <br />LOT aLacK—oF y <br />JOB ADDRESS <br />8014 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 />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY ASH BASIN <br />BOILERS — H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS — TONNAGE EA. <br />KITCHEN SINK 6 DISP. <br />_ <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS — S.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKIN3 FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR. ETC. <br />SUBTOTAL <br />SUBTOTAL $ <br />PERMIT <br />3 <br />PERMIT 3 <br />TOTAL FEE <br />S <br />TOTAL <br />FEE i <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE 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 />BUILDING <br />SL400.00 <br />23 <br />50 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE <br />REQUIRED <br />nYES <br />SPRINKLERS <br />❑NO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (B) <br />2. BUILDING PLANS <br />TOTAL <br />2 3 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />-- <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />4 I �, I 1, 2 3. 5 0 <br />ILD <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />