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the Evergreen <br />cTY OF ^.O NSTRUCTION <br />everett PERMIT PERMIT NO.10979 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑ COMBINATION 1R oUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS C'.TY ZIP PHONE <br />Joseph A. Bohl 421 Avenue I_—.___.___39homt ALh 9829) __ _568-4334 <br />ARCHITECT OR DESIGNER MAIL AC DRESS CITY ZIP RIOIIE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE D <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE P <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSED <br />CLASS OF WORK <br />El NEW []ADDITION ❑ALTERATION ❑REPAI'I ❑DEMOUTICN ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />s 1200.00 <br />Construct flu <br />PROPOSED USE OF BUILDING <br />Single Family Residence <br />I HEREBY CERTIFY THAT I 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED//AGENT 11 DATE <br />X �_nM Q_ , 9/9/82 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />}2-13 828 Everett Div. H <br />La BLOCK_OF <br />JOB ADDRESS <br />3423 Federal <br />PLUMBING <br />MEC NICAL <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 A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK & DISR <br />FORCED AIR SYSTEMS — B.T.0 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 />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL <br />FEE t <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 />❑YES (AND <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />$1200. <br />20 <br />50 <br />SIZE OF BLDG. <br />N0. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />(]YES ❑NO <br />MECHANICAL. <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B C <br />. <br />SEC303(a)—' <br />2. BUILDING PLANS <br />TOTAL <br />20 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION y qp Ep <br />WHEN PROPERLY VALIDATED ON THIS r2j)jHIS ISPOU L Y .o <br />(( 88 as �l`U L% U 5 <br />P <br />_ Cr8. <br />YO'U"-R RECEIPT C <br />THANK YOU <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />- 9 SEP 8 Z <br />ADDRESS FILE <br />