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ni <br />— the Evergreen CITYr <br />OoF f <br />CONSTRUCTION' <br />everett <br />PERMIT PERMIT NO. 12043 <br />CITY HALL 259.6745 <br />EVERETT, WA 98201 El COMBINATION ® BUILDING ❑ MECHANICAL PLUMBING <br />❑Ty 21: PHONE <br />OWNED <br />NICHAEL A. AWTREY 20831 <br />MAIL ADDRESS <br />Frank Waters Rd Stanwood 259-5HON E <br />MAIL ADDRESS CITY 21P PHON <br />ARCHITECT OR DESIGNER <br />CITY Zip PHONE LICENSEt <br />GENERAL CONTRACTOR <br />Bluesky Construction Same <br />MAIL ADDRESS SLUESC 178 DN <br />pNCNE ULENSE. <br />MAIL ADDRESS CITY Zlp <br />M ECHANICAL GONTPACTOR <br />A <br />�.L <br />LITY ZIP PHONE LICENSE <br />PLUMBING GONTRACTOR <br />MAIL ADDRESS <br />❑ALTERATION ❑REPAIR X%] DEMOLITION ❑FENCE ❑SIGN ❑ WOOD STOVFJFIREPLAGE INSERT <br />CLASS OF WORK <br />❑ NEW ❑ADDITION <br />VALUATION OF WORK <br />f <br />DESCRIBE W RK <br />Demo�ish single family residence <br />THAT I HAVE READ AND EXAMINED THIS <br />PROPO ED SEOFBUILDING <br />S ngj family residence <br />I HEREBY CERTIFY <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) CORRECT. ALL PROVISIONS OF LAWS AND ORGINANCES <br />TYPE OF WORK WILL BE COMPLIED WITH <br />1 Short Plat <br />1202-2-83 GOVERNING THIS <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANT114G OF A <br />LOT _—BLOCK�OF <br />O VOLATE <br />AUTHORITY TSTAITTE <br />PRESUMETCANCEL <br />DOES NT OR <br />PROVISIONS OIFEANY OTHER <br />ORRMIT <br />TOE <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF ONSTRUCTION. DATE <br />IGNATURE FCON AUT RIZED AGENT 6/6/83 <br />JOB AOORESS <br />v <br />6924 Col b <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR COND. UNITS — H.P. EA, <br />WATER CLOSET( TOIL ET) <br />REFRIGERATION UNITS — H.P. EA. <br />BATHTUB <br />BOILERS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />SHOWER <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />KITCHEN SINK & OISP. <br />WALL HEATERS — B.T.U. M <br />DISHWASHER <br />UNIT HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE MOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT — C.F.M. <br />FLOOR DRAIN <br />STOVE — WOOD <br />VACUUM BREAKERS <br />METAL FIREPLACE 8 CHIMNEY <br />ROOF DRAINS — RAINLEADERS <br />FIREPLACE INSERT <br />SINK tSERVICE — BAR. ETC.) <br />HEAT PUMP <br />SUBTOTAL f <br />SUB TOTAL <br />f PERMIT f <br />PERMIT <br />f f <br />TOTAL FEE <br />TOTAL FEE <br />f PLAN CHECK FEE <br />REAR YARD SETBACK PLAN CHECK NUMBER <br />RECEIPT NO, <br />SIDE YARD SETBACK STREET SETBACK <br />FEE <br />USE ZONE LOT AREA <br />VACANT SITE FEES VALUATION FEE <br />I, YES ;-:NO <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING UNITS f DD DD <br />BUILDING <br />SIZE OF BLDG. NO. OF STORIES <br />MAX. OCC. LOAD PLUMBING <br />_ <br />FIRE ZONE BASEMENT <br />FIRE. SPRINKLERS MECHANICAL <br />REQUIRED <br />YES FIND OTHER <br />APPROVALS <br />BY DATE <br />UBC <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY SEC, 3031a1 <br />DD 00 <br />2. BUILDING PLANS <br />TOTAL <br />3. FIRE HYDRANT <br />PERMIT VALIDATION r IS IS <br />VALIDATED TIN THIS "ITU •'U—�� <br />A. FIRE PROTECTION SYSTEM <br />WHEN PROPERLY <br />5. GRADING <br />(� <br />6. DRAINAGE <br />7. ENV;RONMENTAL IMPACT STATEMENT <br />YOUR RECEI <br />8. HEALTH DISTRICT ;HANK YOU <br />PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />APPLICATION ACC, BY <br />ADDRESS FILE <br />