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the EverXrecn <br />CITY OF <br />everett <br />CITY HALL i38745 <br />EVERETT. WA 913211O <br />O STRUCTION <br />PIERMIT <br />❑ COMBINATION ❑ BUILDING L� MECHANICAL <br />PERMIT NU. 11110 <br />U PLUMBING <br />OWNER <br />Vern Brokaw <br />MAIL ADDHLSS <br />410 Beech Street <br />-'ll <br />Everett <br />ZIP <br />98203 <br />R•Uh1 <br />355-6449 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CRr <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CRY <br />LIP <br />PHONE <br />LICENSE F <br />Same <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />IK:ENSEf <br />PLUMBING CONTRACTOR MAIL ADDRESS CRY ZIP PHONE LICENSEE <br />CLASS VF MONK <br />❑NEW ❑ADDITION ❑ALTEMTION ❑REPAIR ❑DEMOLITION ❑FENCE 0610N ❑GANGS <br />VALUATION OF WORK <br />L <br />DESCAIBE WORK <br />Tn n* ii Pl.. nt-s nAinrt WAAFT At[OVP_ <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />LEGAL DESCRIPTION Of PR(MERIY (SHOW BELOW OR ATTACH FOUR PORES' <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />ALL <br />LOr SLDCK_OF <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 />- - <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />e,GNATURE O NTRACTOR OR AUTHORIZED AGENT DATE <br />X _..E1- r• �rF�%'�^ 10/7/82 <br />JOB ADDRE' <br />410 Beech Street <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />90. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET OILETI <br />AIR COND.UNITS — H.P EA <br />REFRIGERATION UNITS — H.P. EA <br />_ <br />BATHTUB <br />LAVATORY ASH BASIN <br />BOILERS — H.P. EA. <br />GAS FIRED A C. UNITS -- TONNAGE EA. <br />SHOWER <br />_ <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS — B T U. M EA <br />WALL HEATERS — BTU M <br />DISHWASHER <br />UNIT HEATERS — B T.U. M <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />, <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINIL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDING UNIT — C.F.M. <br />1 <br />STOVE Wood <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEAOLR6 <br />METAL FIREPLACE 6 CHIMNEY <br />SINK ISERVICE — BAR. ETC. _ <br />TOTAL <br />SUB T <br />SUBIIT <br />SUB TOTAL f <br />_ 7 <br />50 <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL <br />FEe <br />f <br />SIDE YARD SETBACK STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECi <br />f LE <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VAW ATION <br />FEE <br />TYPE OF CONS f. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDG. <br />NO, OF STORIES <br />MAX. DOC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIq OU RED RE SPRINKLERS <br />MECHANICAL <br />17 <br />50 <br />-- <br />I!YES LINO <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U B C <br />SEC 3U3lal <br />TOTAL <br />17 <br />50 <br />2. BUILDING PLANS <br />3 FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED KIN THIS SPACE) THIS IS YOUR PERMIT <br />7• 5 0 �� A <br />35 17 O' M1 <br />/ <br />6. GRADING <br />6 DRAINAGE <br />a --I <br />YOUR RECEIPT`' <br />YOU <br />• . <br />7. ENVIRONMENTAL IMPACT STATEMENTAEEE: <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BYTHANK <br />ADDRESS FILE _ . - - 4 OCT 8Y <br />