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the Evergreen CITYOFF COSTRUCTION jo <br />CITY <br />everett PERMIT PERMIT NO. O 7342 <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING ki MECHANICAL ❑ PLUMBING <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />Jean R. Fosheim <br />2927 Federal <br />Everett <br />98201 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSED <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />Natural Gas Equiplent 1611 East Grand 258-2441 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />S <br />DESCRIBE WORK <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 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 />SIGNAT RE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ,' 1 . I ,(1• 3/17/80 <br />LEGALDESCRIPTION OFPROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />OT BLocK_oF <br />JOB ADDRESS <br />2927 Federal <br />PLUMBING <br />MECH NICA J <br />NO. <br />THE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />., ATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS— H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK 8 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 — BT.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />P.00F DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK(SERVICE — BAR. ETC .1 <br />1 <br />HOt water iter <br />SUB TOTAL <br />SUBTOTAL $ <br />2 <br />O <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE S <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 />OYES ONO <br />FEES <br />VALUATION <br />_ <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWLLLING UNITS <br />BUILDING <br />5 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE <br />REQUIRED <br />OYES <br />SPRINKLERS <br />ONO <br />MECHANICAL <br />S <br />O <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />S <br />0 <br />4. FIRE PROTECTION SYSTEM <br />- <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />96 29 <br />M <br />f� <br />YOUR R Ec E W o <br />7I "Al-11K You <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE 1 7 IIA2 80 <br />