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the <br />`1e7Y <br />GiTOF ;ONSTRUCTIOP' <br />V OI <br />everett PERMIT PERMIT NO. 16217 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING J® MECHANICAL ❑ PLUMBING <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />MADELINE MC CAFFREY <br />4214 FEDERAL <br />EVERETT WA <br />252-3034 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE M <br />VALLEY NATURAL GAS <br />10323 Highway 99 <br />Everett WA 98204 <br />355-7730 VALLENG153LI <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P PHONE LICENSE N <br />CLASS OF WORK❑ <br />F NEW ❑ADDITION ❑ALTERATION ❑REPAIR El DEMOLITION of NCE ❑SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />OF <br />UQ� Iu�na�.c ens <br />PROPOSED USE OF BUILDING <br />Residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNAT�URj OF CONTRACTOR OR U HORIZED AGENT DATE <br />X--(/ 3 12 86 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT__BLOCK_01: .y <br />yt <br />JOB ADDRESS <br />4214 Federal <br />PLUMBING <br />MECHANICAL IV <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 />_ <br />BATHTUB <br />REFRIGERATION UI41TS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />13� <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.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 — WOOD <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL <br />f <br />SUBTOTAL S <br />PERMIT <br />f <br />PERMIT $ <br />To— <br />7u— <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />xxxiall <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETP.ACK <br />PLAN CHECK NUMBER <br />PLkN <br />FEE <br />CHECK FEE LU Du <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA I <br />VACANT SITE <br />_:YES NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX, OCC. LOAD <br />PLUMBING <br />+ <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES ENO <br />MECHANICAL <br />I 20 <br />50 <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (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 <br />WHEN PROPERLY VALIDATED (IN THIS � �j THIS 1I$xQ�IF�PER�1T (� <br />(JJ <br />CV <br />(_CJ <br />`, It P L� r- <br />I IBC E I ` 1 <br />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 BV <br />I I I""R 8G <br />�m <br />H m <br />m <br />mo <br />c1 <br />o� <br />—1 z <br />m —� <br />m _ <br />A Z <br />C <br />a -H <br />1 N <br />< <br />O A <br />�1 D <br />3 <br />--4 m <br />S <br />m .+ <br />N <br />v <br />o r <br />n m <br />C N <br />3 N <br />m <br />z c� <br />-� r- <br />• m <br />D <br />A <br />Z <br />O <br />r-. <br />m <br />m <br />ADDRESS FILE <br />