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'h`E"�gYeoF - �ONSTRUCTIOM � �� <br />everett PEr�MIT PERMIT N0. O873Z <br />GTY HALL 259�8745 � <br />EVERETT, WA 99201 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING <br />OWNER MRILADOflESS CI7Y 21P PMONE <br />RALPH E. HHMPHREY 4019 FEDERAL EVBRETT 98201 259-1512 <br />AflCHIiECi OFl DESIONEfI MAIL A�DRESS CITY 21P PMONE <br />GENEflAL CONTRACTOH MAII AUOf1E5S QTY ZIP PNONE UCENSE � <br />1,1ECNANICALCONTRAC70R MNLADDRESS CIiY ZIP FHONE LICENSEI <br />SELF <br />PLUMBINGCONTRACTOfl MAILAODBE55 CITV IIP PMpNE LICENSE� <br />ClASS OF WOFK � <br />C�NEW ❑ADDITION C]ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />3 <br />WORK <br />INSTALL WOOD <br />LOT BLOC�_OF <br />F <br />PLUMBINO <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSE7 ROII Fn <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINI.EP.DERS <br />SINK (SEfiVICE — BAR, LTC.1 <br />SUBTOTAL <br />PERMR S <br />TOTALFEE f <br />SIDE YARD SETBACK STREET SETBACK REAR YF <br />UFE ZONE LOTAREA VACANT <br />❑YES <br />NPE OF CANST. OCCI:PANGY GROUP NO. OF I <br />SIZE OF BLDG. NO. OF ST�HIES MAX. OC <br />FIRE ZONE 9rSEMENT FIRF SPt <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMEN7ALIMPACTSIATEMENT <br />8. HEALTH DISTRIL'T <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <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 />SIGI�A�'� F C AC O qBTHOP AGENi DATE <br />x C•� Ef ' � iiiiei <br />� <br />MECHANICAL <br />N0. TYPE OF EOUIPMENT FEE <br />_� AIR COND. UNITS — H.P. EA. <br />� REFFIGERATION UNITS — H.P FA <br />n�i�ena — n.r. eH. <br />GAS FIRED A.C. UNITS — 70NNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />VENTILA710N FAN <br />AIR HANDLING UNIT — <br />METAL FIREPLACE 8 <br />OTHER <br />PENALTY <br />PERMIT <br />FEE I RECEIP7 NO. <br />8 <br />U.B.C. <br />SEC. 303 (a) <br />PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />N <br />z3�a �007.50 --`'4 <br />� <br />� <br />� �; � � �cr:i�T <br />� . :;;r� ; �ro u <br />ADDRESS FILE — �,Ib'a R I <br />