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r <br />r <br />L <br />�heEvergreen � - ^ONSTRUCTION � � <br />CITY OF <br />everett PERMIT pERMIT NO. 116H2 <br />CITY HALL 259�B7A5 <br />EVERETT, WA 982�1 ❑ COMBINATION ❑ BUILDING C� MECHANICAL ❑ PLUMBING <br />O'NNER MPILAD�PL55 GIIY 21V PMONL <br />no�arn RFFDiF 16 FF.RN ROAD F.VERETT 'iSS-5265 <br />ARCHITEC-0fl0E51GNER MFILADDR[55 CITY ZIP PIIONE <br />GENhPALGONiRAQOii MFILqDDRE55 CITY 21P PHONE LICENSEI <br />MCCIIANICFLGONTRACTOH MAILAppRE55 CITV ZIP FMONE UCENSE� <br />otanrn a <br />PLUMBING COViPACTOfl h1Al� ADDPE55 CITY ZiP PHONE UGENSE I <br />GLASS OF WOFi: <br />QS� NEW <br />5 <br />Wood stove <br />PPOPOSED USE OF BUILDING <br />Residence <br />LEGAL OESGRIPTION OF PROPEPT' <br />ior eiaK_oF <br />❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />�oa nooaess <br />16 Fern Road <br />PLUMBING <br />NO. TYPE OF <br />WATEfl CLOSET ( i OILE <br />BA7HTU0 <br />LAVATOflY�WASH 9A5 <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRY TRAV <br />CLOTHES WASNER <br />WATER HEATCP <br />URINAL <br />DflINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAIp <br />SINK ISFRVICF — BAP <br />SIDE YARD <br />ZONE <br />STREET SETBACK <br />LOT AREA <br />OCCUPANCV G9( <br />NO. OF STORI[5 <br />BASEMENT <br />FEE <br />REAR YARD <br />❑YES ❑NO <br />LiL•B1 <br />t. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HVDRANT <br />4. fIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH OISTRICT <br />APPUCATION FCC. BY PLANS CHECKED BY 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 WI � H 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 />CUNSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTHACT/O�F OR AUTIIOPIZEO FnGE/N�T DATE <br />X�rsx.al�c�l ��o 0 oJCX� _ 4/ 7/ 8 3 <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />�11R COND. UNITS — H P. EA. <br />FEFRIGERATION UNITS — H. <br />BOILERS — H.P.EA. <br />GAS FIRED AC. UNITS — TONNAGE EA. <br />FOF7CED AIR SVSiEMS — B.T.U. M <br />WALL HEATERS — B.i.LL M <br />UNI7 HEATERS — B T.U. M <br />EVAPORATIVE COOLERS <br />VENTIL4TION FAN <br />FEES <br />FEE I RECEIP7 NO. <br />S <br />MECHANICAL I I 1� ISO <br />PENALTY U.B.0 <br />SEC. 303 (a) <br />PEXMIT VALIDATION <br />WHEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5435 �0 I 1.50 -- 04 <br />�0 <br />1--� <br />YOUr REC[IFT� <br />11-1f�i�J� YOU <br />ADDRESSfILE <br />- � aP� a 3 <br />� <br />