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the Evergreen <br />_ C NSTRUCTION <br />CITY OFF <br />everett <br />PERMIT <br />PERMIT NO.OH77O <br />CITY HALL 259 8745 <br />❑ <br />COMBINATION ❑ BUILDING [))MECHANICAL <br />❑ PLUMBING <br />EVERETT, WA 98201 <br />OWNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />Gene Fosheim <br />2927 Federal #5 Everett <br />98201 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LIC-NSEI <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE 0 <br />Natural Gas <br />Equipment 1611 East Grand Everett <br />98201 258-2441 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE IF <br />11�. V'n 1 ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION El FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />T <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />OR ATTACH FOUR COPIES) <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />LOT BLOCK —OF <br />HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STP fE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR 04 AU I: ED AGENT DATE <br />JOB AQ06h Federal #5 <br />E 1/15/81 <br />X <br />PLUMBING <br />1E CAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND UNITS - H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS - H.P. EA. <br />SHOWER <br />GAS FIRED AC. 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 />_ <br />UNIT HEATERS - B.T.U. M <br />I WATER HEATER <br />URINAL <br />"""""" I. - " -- <br />VENTILATION FAN <br />RANGE HOOD <br />I" DRINKING FOUNTAIN <br />AIR HANDLING UNIT - C.F.M. <br />I' <br />FLOOR DRAIN <br />1 <br />STOVE <br />METAL FIREPLACE 8 CHIMNEY Imo! <br />Circul atin Heater <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINK(SERVICE - BAR. ETC.) <br />�R <br />SUB TOTAL <br />fI <br />�' SUB TOTAL S <br />PERMIT S <br />PERMIT $ <br />TOTAL <br />FEE S <br />TOTAL FEE S <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK <br />FEE RECEIPT NO. <br />USE ZONE LOT AREA VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG. NO. OF STORIES MAX. OCC. LOAD <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />ysy; <br />3. FIRE HYDRANT y9 4 _ <br />4. FIRE PROTECTION SYSTEM 11 <br />5. GRADING <br />6, DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8, HEALTH DISTRICT <br />APPLICATION ACC, BY PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />MECHANICAL 9lfe I 9 IOC <br />PENALTY U.B.0 'u� r <br />SEC. 303 IQ <br />TOTAL Loo <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPA W )HT IS YOOSSR;'PgI T O <br />LL CC JJ O <br />r- <br />R R,:CEIt& <br />I" Y G ItD <br />