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I <br /> i <br /> � <br /> thr 6Yrrgreen . - <br /> �:,,,�F C�IVSTRUCTION I <br /> everett PERMIT <br /> PERMIT NO. 09077 <br /> c�rv �+A��as,s��s <br /> ev=_aerr.wn �a���o� LI COMBINATION 7� BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNER MAILPDORESS CITV ZIP PHONE I <br /> Thomas Hauqstad 4732 Hlack Forest Lane Everett 98203 252-8943 <br /> ARCNIiEC10F0E51GNER MrIILA�OFE55 CITY ZIP PMONE <br /> GENEPPL CONTRACLOP MAIL F�OFESS Gtt ZIP PHONE LICENSE Y <br /> Same <br /> � MELHnNICHLCONTRACiOP MAI�N�DRE55 CIiY ZIP PHONE LIGENSEY <br /> PLUM9INGCONTRAC[OF MAILN��FESS Qtt ZIp PHONE LICENSEI <br /> I <br /> CLASS OF WLRK <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FEiJCE ❑SIGN �'iARAGE <br /> VRWATION OF WOf1N <br /> $ a,000.00 <br /> DESCRIBE WORK <br /> Construct car/port type building <br /> PROPoSEO USE OF BUILDING � <br /> single family residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �eca�oesceiario�+ocPaoaee*v�sNoweeiowoAnnneNFouaeoaies PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> S 132 , 5' of the NE�a OF ALL PROVISIONS Of LAWS AND ORDINANCES GOVERNING THIS <br /> �o* eice�oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFlED <br /> the S.E. � of Government Lot 3 Sec 31 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 REGULATMG , <br /> Twn 29N Rge SEWM CONSTRUC710N OR THE PERFORMANCE OF CnNSTRUCTION. <br /> JOBFDDPE55 SIGNATURE R TOfl�RIZEDAGENt DATE <br /> 4732 Black Forest Lane X � <br /> PLUMBING MECHANICAI � <br /> NO. 7YPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET{TOILET) AIR COND.UNITS—H.P.EA. <br /> BATHTUB REFRI6ERATION UNITS—HA EA i <br /> LAVATORV�WASH 6ASIN) BOILEFS—H.P.EA. _ ��. <br /> � SFIOWER GAS FlRED A.C.UNITS—TONNAG`_EA. I <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B T.U. M EA. � <br /> DISHWASHER WALLHEAiERS—B.T.U. M I <br /> IAONDRY TRAV UNIT HEATERS—B T.U. M I <br /> CLOTHES WASHER EVAPORATNE COOLERS <br /> WATER HEATER CLOTHES DRVERS I <br /> URINAL VENTILATION FAN 'I <br /> DRINKING POUNTAIN RANGE HO00 '� <br /> fL00P DRAIN AIR HANDLING UNIT— GRM. ' <br /> VACUUM BREAKERS STOVE i <br /> ROOF DRAINS—RAINLE4DERS METAL FIFEPLACE&GHIMNEV i <br /> SINK(SERVICE—BAR,ETC; � <br /> 1 <br /> SUB TOTAL 5'JB TOTAL f <br /> � PEPMIT f PERMIi f <br /> TOTAL FEE f TOTAL FEE f <br /> SIDE VARD SETBAGK STREET SETBACK REAR YARD SETBACk PLAN CHECN NUMPER PLAN CHECK FEE <br /> 6' 61/9077 FEE 26,93 REceiPrrvo. <br /> USE ZONE LOT AREA VACANT SITE 5 3119-S <br /> g_I i lYES $I}�0 FEES �04UATIQk FEE <br /> TYPEOFCqNST. OCCUPANCYGROUP NO.OFOWELLWGUNITS <br /> V—N M—I I <br /> eui�o�Nc $4,000. 44 50 <br /> SI2E OF BL�G. N0.C�STORIES MAX.OCC.LOAD <br /> I P W MBING <br /> FlRE ZONE BASEMENT FlRE SPRINKLEflS MECHAN�CAI. <br /> REOUIR€�D <br /> rnEs atXo <br /> RPPROVALS BY DATE OTHER <br /> t ENVIRONMENTALCHECK UST pENA�ty U BA. <br /> SEC.303(a) <br /> 2 BUILDING PLANS <br /> ioia� 44 50 <br /> 3. FIRE HYDRANT <br /> 4. FIqE PROTECTION SVSTEM PEflMIT VALIDIITION <br /> WHEN PROPEPLV VALIDA�E�(IN THIS SPACE)TH15 15 YOU9 PERMIT <br /> 5. GRADING � <br /> 6. DRAINA6E ( � ' I r �� �� ;� C ' — <br /> l. ENVIRONMENTALIMPACT STATEMENT 0 <br /> � <br /> 8. MEALTH�ISTRICT . . T � <br /> � APPLICATION ACC.BV PLANS CMECKED BV APPR.FJR ISSUANCE BV � '� + <br /> v.c. , . J <br /> ADDRESS FILE � � � � <br />