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he <br />` fib CIF r-ONSTRUCTION <br />everett PERMIT PERMIT NO. 17986 <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />R.R. Pierre 8018 Beverly Blvd Everett, WA 98203 353-2980 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSI'0 <br />Self <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE II <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR 'E7 DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />S <br />DESCRIBE WORK In accordance with Board of Appials order dated 3-31-87, within 30 days of issuance <br />Demolish of demolition permit, the structure shall be demolished and area cleared. <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. 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 <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONT R, HORI AGENT, OR OWNERO <br />J( % <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT 26 BLOCK 5 OF Beverly Park (Lot 1) <br />JOB ADDRESS <br />8016 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 />A/C - A/HNDLG UNITS - H P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY ( WASH BASIN) <br />I <br />BOILERS - B.T.U./H.P. <br />SHOWER <br />GAS FIRED ABC. UNITS - B.T.U. <br />KITCHEN SINK d 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 />_ <br />URINAL <br />CE-ITHES DRYERS <br />_ <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />IRANGEHOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD .;TOVE <br />_ <br />SINK (SERVICE - BAR, ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAII <br />SUBTOTAL <br />f <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTALFEE <br />f <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />Vn1.UATlCii <br />FEE <br />BUILDING <br />S —D— <br />— <br />— <br />TYPE OF CONST <br />OCCUPANCY GPOUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />�50 <br />*13:: <br />SIZE OF BLDO <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />GOAIe) <br />.50 <br />STATE BUILDING SURCHARGE <br />HO0D26i Z <br />1 <br />50 <br />STATE ENERGY SURCHARGE <br />CHECK 4 <br />.58 <br />.00 <br />APPLICATION ACC BY <br />M.M. <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />M.P. <br />DRIVEWAY PERMIT <br />TOTAL <br />1150 <br />PVnMIT VALIDATION <br />WHEN PROPERLY VALIDATED RN THIS SPACE) THIS IS YOUR PERMIT Co <br />OD <br />Q� <br />ADDRESS FILL <br />