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The Evergreen CITY OF Cf NSTRUCTION <br />everett PERMIT PERMIT NO.08550 <br />CITY HALL 2598745 <br />EVERETT, WA 98201 El COMBINATION ❑ BUILDING ❑MECHANICAL SAY. PLUMBING <br />OWNER MAIL ADDRESS .,:Ty ZIP PHONE <br />C. E. Norberg 4926 Colby <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />PLUMBINGLONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE III <br />Jacobson Plumbing 1530 Grove Street Marysville 659-1002 <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN (]GARAGE <br />VALUATION OF WORK <br />DESCRIBE <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 FOJR COPIES) <br />LOT 13LOCK_OF <br />1JU <br />4926 Colby <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 />2 <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 />00 <br />BOILERS -H.P. EA. <br />SHOWER <br />GAS FIRED A C. UNITS - TONNAGE EA. <br />KITCHEN SINK & 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 -8.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C P M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE - BAR, ETC) <br />SUB TOTAL <br />_ 6 <br />0 0 <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE $ <br />q- <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES E]NO <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 />00 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />AYES []NO <br />MECHANICAL <br />— <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />_ <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />9 <br />00 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />0 2 94 $ 0 0 9.0 0 -- <br />Ln <br />R �11IR RECEIPTC00 <br />D <br />' i' ! 'I. t IK\ Y G U <br />5. GRADING <br />. <br />6DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />3. HEALTH DISTRICT <br />APPLICATION ACC. 8Y <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />10 icy 8 0 <br />