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� <br /> '_ (ItCEveCfgYf�IF7 , ('-�NSTRUCTION h~~ � <br /> everett PERMIT PERIVIIT NO. 09754 <br /> CITY HALL 259�B7d5 <br /> EVERETT.WA 98201 ❑ COMBINATION ❑ BUILDING � MECHANICAL PLUMBING <br /> OWNER <br /> MAILADDRES$ GIiY 21P PhO��E <br /> A1 Bolser 5530 Evergreen Way Everett 98203 <br /> ARCMITECTOROESIGNER IAAILA�DRE55 CIiY Z�P PNONE <br /> GENERALCANTRAGiOR MAILADDRESS Cltt 21P PNONE IICE�lSE/ <br /> Les W:iite Const. 306 73rd Street S .W. Everett 98203 355-9680 <br /> MECMANIGALCANTlIACTOR MAILADDFE55 CIiY 21P PHONE LICENSE/ <br /> PWIABWGCANTRACiOR lAAILAOGRE55 CIiY ZIP PHONE ULENSE/ <br /> CLASSOF WORK } <br /> �]ryyEW ❑FDDITION ❑ALTERATION ❑REPAIR ❑�EMOLITION ❑FENCE ❑SIGN GARAGE <br /> VPLUATION OF Y/ORK <br /> E <br /> OESCflIBE WORK Z <br /> O <br /> �--I <br /> .-� <br /> PFOPOSED USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- m <br /> LiGAl0E5GHiFTIONOFPflOPERN�SMOW BELOW OPATfACH FOUFCOP�ES) PUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. " <br /> ALL PRUVISIONS OF LAWS AND ORDINANCES GOVERNING 1'HIS <br /> ior BLOCK_OF 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 CANCELTHE PRO- �' _ <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING � o <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. m � <br /> SIGNATURE OF CAN7pA OR OR AUTNO Ep AGENT OATE <br /> JOB ADDRESS � 3 <br /> 5530 Ever reen Way X� 9/8/81 = � <br /> PLUMBING MECHANICAL m <br /> .o i <br /> Np, TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE � <br /> WATER CLOSET(TOILEn AIR COND.UNITS—H P.EA. _ r = <br /> BATHTU(3 REFRIGERATION UNITS—H.P.EA � y <br /> LAVATORY(WASH BASIN) BOILERS—H.P.EA. '� <br /> GAS FIRED AC.UNITS—TONNAGE FA. O 7� <br /> SHOWEfi T� <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.LU. M EA. <br /> VlALL HEATERS—B.T.U. M —I m <br /> DISHWASHER <br /> UNIT HEATERS—B.T.U. M m `� . <br /> LAUNDRYTRAY y <br /> CLOTHES WASHER EVAPORATIVE COOLERS � <br /> WAT[R HEATER CLOTHES DRVEfiS n m <br /> C N <br /> 1 VENTILATION FAN 3 � <br /> URINAL m <br /> DRINKING FOUNTAIN RANGE HOOD Z C� <br /> AIR HANDLING UNIT— C.F.M. �m <br /> FLOOR L�FAIN � D <br /> VACUUM BflEAKERS STOVE p <br /> ROOF DRAWS—RAWLFADERS METAL FIREPLACE u CHIMNEY � <br /> 2 <br /> SINK�SERVICE—BAP.ETC.) n <br /> 2 <br /> / � <br /> S <br /> �--� <br /> N <br /> SUB TOTAL SUB 70TAL S 2 00 z <br /> PEFMIT f 3 0 � <br /> � PERMIT S — � <br /> TOTALFEE S TO7ALFEE S n <br /> PtAN CHECK FEE m <br /> SIDE YARD SETBACK STREET SETBACK FFAR YARD SETBAGK PLAN CHECK NUMBER pECEIP�N0. <br /> FEE <br /> USE ZONE LOT APEA VACANT SITE FEES VALUATION FEE <br /> ❑VES ❑NO <br /> NPE OF CANST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING � <br /> SIZE OF BLDG. NO.OF STORIES MA%.OCC.LOAD <br /> PLUMBWG <br /> FIRE ZONE OASEMENT pEpUIRED KLERS MECHANICAL S 00 <br /> ❑YES ❑NO <br /> APPROVALS <br /> BY DATE �THER <br /> 1. ENVIRONMENTAL CHECK LIST PENALTV U.B.C. <br /> SEC.303(a) <br /> 2. BUILDINGPLANS TOTAL 5 00 <br /> 3. FIRE NYDRANT <br /> 4. fIRE PROTECTION SYSTEM PERMIT VALIOA710N <br /> WHEN PFOPERLY VALIDATED(IN THIS SPACEI7NI515 YOUP PERMIT <br /> 5. GRADING ' ' L ; :'� ;'1 � (' � ___ � <br /> 6. DRAINAGE � <br /> 7. ENVIRONMENTAL IMPAGT STATEMENT � <br /> 8. HEALTH�ISTRIC7 ' � ;.' � � <br /> APPLICATION ACC.BY PLANS CHECNE�BY APPR.fOR ISSUANCE BY <br /> K.C. <br /> ADDRESS FILE � � � <br />