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the Evergreen <br />cr N ST R U CT I O N <br />OF <br />CITY OF <br />everett <br />PERMIT <br />PERMIT NO.08550 <br />CITY HALL 259-8745 <br />EVERETT,WA 98201 <br />L COMBINATION ❑BUILDING ❑ MECHANICALcPLUMBING <br />OWNER <br />MAIL ADDRESS VTY <br />LIP <br />C. E. Norberg <br />4926 Colby <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE 0 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE IF <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSED <br />Jacobson <br />Plumbing <br />1530 Grove Street Marysville <br />659-1002 <br />CLASS OF WORK <br />❑NEW <br />❑ADDITION <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE <br />❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />f <br />DESCRIBE WORK <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 />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 />SIGNATU NTRACTOR OR AUTHORIZED AGENT DATE <br />XT 11/10/80 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT RLGCK_-DF <br />JOB ADDRESS — <br />4926 Colby <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />2 <br />00 <br />AIR COND. UNITS — H P. EA <br />BATHTUB <br />2 <br />00 <br />REFRIGERATION UNITS — H,P. EA <br />1 <br />LAVATORY (WASH BASIN) <br />2 <br />OO <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — BT U. M EA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />_ <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 UNIT — CFM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />CIIJK ICFRVIr..F - RAP FTr,1 <br />PERMIT $1 <br />1 <br />n <br />PERMIT 11 <br />TOTAL FEE S <br />g=I <br />I <br />TOTAL FEE $ <br />SIDE YARD SETBACK <br />...HEFT SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAID CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST, <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG. <br />NO, OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />9 <br />OO <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REOUIRED <br />❑YES ONO <br />MECHANICAL <br />_ <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />9 <br />OO <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />0 2 9 4 $ 0 0 9.0 0--� <br />L(j <br />L.L <br />,r '.I R R E C E I PTo <br />A, "J Y G U <br />5. GRADING <br />6. DRAINAGE <br />T ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY I PLANS CHECKED BY <br />I <br />APPR. FOR ISSUANCE RY <br />