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L <br /> iheG�rrgreen CC ySTRUCTION <br /> CITY Of <br /> everett PERM IT pEl <br /> CITV HALL 259�8745 <br /> EVERETT,WA se2o� � COMBINATION � BUILDING ❑ MECHANICAL PU <br /> A!AILADOAE55 C�iY 21f <br /> CYJNER <br /> Roger L. Kulbeck 3914 Gardena Longview 98632I <br /> uaanooFess aTM znl <br /> ARCHREGi OR D[SIGNER ' i <br /> GCNERAL GONiMCTOR <br /> MAILADORE55 CITY 211' <br /> S ame Z, <br /> MEGHhNIGLCONiRFGTOA <br /> MAIL ADORE55 GITY <br /> PW MBING CANiRACiOR <br /> MAILADDP[55 CITY 21 <br /> CLA55OF WORK <br /> �rygy ❑ADDITION ❑ALTERATION �7EPAIR ❑DEMOLITION ❑FENCE SIGt <br /> VAWATION OF WORK <br /> f �.rJ00.�0 <br /> OESGPiBE WORK <br /> re-roof com <br /> PROPOSED USE OF BUILO�NG <br /> single family residence I HEREBY CER?IFY THAT I HA <br /> PLICATION AND KNOW THE : <br /> LEGAL DESCRIPTION OF PROPERTY�SN01V BELOW OR ATTACH FOURfAPiES) ALL PROVISIONS OF LAWS AP <br /> �o, 45 eLaK_oF Mount Baker View TYPE OF WORK WILL BE COA <br /> HEREIN OR NOT. THE GRA <br /> PR[SUME TO GIVE AUTHORIT' <br /> VISIONS OF ANY OTHER ST� <br /> CONSTRUCTIO�J OR THE PER <br /> Sicr+aruaE ov corvrnncroa or+numoni <br /> JOZZ3REB1]d ewa X Check #2893 <br /> 4 Y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUI <br /> AIR CCND.UNITS—HP.EA. <br /> WATER CLOSEi ROILET) <br /> REFFiIGERATION UNITS—Hl <br /> BATHTUB <br /> 601LER5—H.R EA. <br /> IAVATOPYIWASH BASIN) <br /> GAS FIRED AL UNITS—TGI <br /> SHOWER <br /> FORCED AIH SVSTEMS—I3 7 <br /> KIiCf{EN SINK 8 DISP. <br /> VJAL1.HEATERS—B.T.U. <br /> DISIiY�ASHER <br /> UNIT HEAiERS—BT.U. <br /> LAUNORY TfiAY <br /> [VAPORATIVE COOLEFS <br /> CLOTMES WASHER CLOTHES DRYERS <br /> WATER HEATER <br /> �ENTIUITION FAN <br /> URINAL <br /> RANGEHOOU <br /> ORINKING FOl1NTAIN �� <br /> FLOOR DPAIN AIR NANDLING UNIT— <br /> VACUUM�REAKERS STUVE <br /> ROOF DHAINS—RAMLEADERS <br /> METAL FIREPIACE 8 CHIMNI� <br /> SINK ISEFVICE—DAR.ETC.) <br /> ._ SUB <br /> SUBTOTAL <br /> PEHMI7 S PER <br /> TOTAIFEE S TOT <br /> SIDE YARD SETBACK . STREET SET�ACK REAR VARD SETBACK PLAN GHECK NUtdBER <br /> USC ZONE Lt'AREA VACANT SITE FEES <br /> UYES ❑NO <br /> TYPE OF fANST. OCCUPANCV GROUP NO.OF DWELLING UNITS <br /> BUILDING <br /> SIZE OF BLOG. N0.OF STOHIES MAX.OCC.LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIPE SPRINKLERS MECNANICl�L <br /> REOUIRED I <br /> IlYES i�NO <br /> APPROVALS <br /> BY DATE OTHER <br /> i. ENVIRONMENTALCNECKLIST PENALTv <br /> 2. DUILDING PU1N5 TOTAL <br /> 3. FIRE HYDRANT <br /> PEPMIT VALIDATION <br /> 4 FIRE PROTECTION SYSTEM WHEN PROPERLY VALIDATED IIN- <br /> 5. GRADING <br /> 6. DRAINAGE <br /> 7. LNVIfiONMENTAL IMPACT STATEMENT <br /> 0. HEALTH DISTflICT <br /> APPLICATION ACQ�Y PIANS CHECKE�BY APPR.FOR ISSUANCE BY <br /> �.DDR�SS FILE <br />