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1 <br /> �^et°�;XY`�° �ONSTRUCTION <br /> everett PERMIT pERMiT NO. 1113H <br /> QTV HAL�259�87a5 <br /> evEaer�,wn eazo, ❑ COMBINATION � BUILDING ❑ MECHANICAI O PLUMBING <br />, JWNER MNILADDRE55 CIiV 21P PMONE <br />� � Thomas R. Haugstad 4732 Black Forest Lane 98201 252-8943 <br />�I ARCHRECT OR OESiGNEF MA1L ADORESS CITV ZIY PNONE <br /> GENEP�L CONiRAGTOR MAII FDDPE55 CIiY ZIP PMONE LIGENSE/ <br />( Same <br /> MECHANICAI CONTMCTOR MNIL AODRE55 CITY ZIP PHONE LICENSE I <br />( <br />� PLUMBINGCONTRACTOR MAILAOOFESS CITY ZIP PHONE LICENSEY � <br /> CLASSOf WOFK <br /> ❑NEVV ❑ADDRION ❑AITEBATION ❑REPAiR ❑DEMOLITION ❑FENCE ❑SIGN �L'3ARAGE <br /> VNLUATION OF WORK <br /> E 11,000.00 <br /> OESCRIBE WOFK <br /> Construct Garage <br /> PROPOSEO USE OF BUILDING <br /> Single Family Residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �ec,n�oesceiv*ioHOFcaoaearvesr�owee�owoannncHFouacoriEs� PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THlS <br /> �o* 3 a�acK_oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> NEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> 31—2 9—5 PRESUME TO GIVE AUTHORITY TO VIOLATE OR�ANCEL THE PRO- <br /> � VISIONS OF ANY OTHER STAT LOCAL LAW REGULATING <br /> CONSTRUCTION THE PE MA CE OF CONSTRUCTION. <br /> SGNATU O TOROR Z[D T DATE <br /> JOB AD�RE55 L <br /> 4732 Black Forest Lane �Cz �' .-� � , 10/27/E2 <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) AIR GOND.UNITS—H.P.EA. <br /> BATHTUB � REFRIGERATION UNITS—H.P EA <br /> LAVATORV(WASH BASIN) BOILERS—H.fl EA. <br /> SHOW ER GAS FlRED A G UNITS—TONNAGE EA. <br /> KITCHEN SINK&DISP. FORCED AIR SYSTEMS—B T.U. M EA. <br /> DISHWASHER , WALLHEATERS—BT.U. M _ <br /> L4UNDRV TRAV ' UNIT HEATERS—BSL. M <br /> CLOTHES WASHER 6VAPORATNE COOLERS <br /> WATER HEATER G�OTHES ORYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN _ RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> � VACUUM BREAKERS STOVL <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE&CHINNEV <br /> SINK(SEPVICE—BAR,ETC.) <br /> SUB TOTAL SUB TOTAL S <br /> VERMR � S PERMR S <br /> TOTRL FEE f TOTRLFEE f <br /> SIDE VAFD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> 6' 20� Z�� 82/11138 FEE 56.23 0172�P60200 <br /> USE ZONE LOT AREA VACANT SITE FEES VALUpTION FEE <br /> � R_1 LlYES f]NO <br /> 7i�S <br /> TVPE OF CANST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> V-N M-1 1 BUILDmG b 11,000. 86 50 <br /> SIZE OF BLDG. NO.OF STORIES MA%.OCC.LOAD <br /> SOBO S . Ft. 1 PLUMBING <br /> PIPEZONE BASEMENT FIRESPRWKLERS MECHANICAL <br /> REQUIRED <br /> ❑VES $�QiO <br /> • AFPROVALS BY DRiE OTHER <br /> L ENVIRONMENTAI CHECK LIST PENALTV U BC. <br /> SEC.903(e) <br /> 2. BUIIDING PLANS <br /> TOTAL 86 50 <br /> � 3. FIFE HVDRANT <br /> 4. FIRE PROTECTION SYSTEM PERMIT VALI011TION <br /> 5. GPADING `NHEN PROPERLY VPLIDATED(IN THIS ePt�)TH151$]ODUR_PERMIT� —_�< <br /> » t � Ea 1 <br /> ' e. oanrr�t� • : M <br /> ]. ENVIPONMENiALIMPACT$TATEMENT � (� � •t 1 �}� <br /> 8. HEAITHDISTRICT �`+�� RCQE�TI r..� <br /> APPLICATION ACC.BV PLANS CHECKED BV APPR.FOR ISSUANCE BY '{���K �If\l� <br /> vv <br /> SG HWM LC , ' <br /> 27 � 81 <br /> AD�RE55 FILE <br />