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L <br />The Evergreen CITY OF CONSTRUCTION' <br />everett PERMIT PERMIT N0. 1OH63 <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING lik MECHANICAL ❑ PLUMBING <br />OWNER <br />BEVERLY A. BEARD <br />MAIL ADDRESS <br />27 Fern Road <br />CITY <br />Everett <br />ZIP <br />98203 <br />PHONE <br />355-6056 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />Owner <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE ♦ <br />•q} <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSED 1 <br />CLASS OF WORK <br />❑NEW ❑ADDITION )(RIALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE <br />❑SIGN <br />❑GARAGE <br />VALUATION OF WORK <br />S <br />DESCRIBE WORK <br />Installation of zero <br />clearance fireplace <br />PROPOSED USE OF BWLOING <br />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 />SIGNAT E OF C^NTP 0 UTHORIZED AG DATE <br />X 8110/82 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK_OF <br />JG9 ADDRESS <br />27 Fern Road <br />PLUMBING <br />MECHANI L <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />I 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 8 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA, <br />DISHWASHER <br />WALL HEATERS — B T.U. - <br />;M-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 />RA14GE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT f <br />TOTAL FEE S <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT N0. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />LiYES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CLNST. <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 />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ❑NO <br />MECHANICAL <br />�/ <br />d <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />M <br />t gaisO 17.50 -- � <br />7 <br />O <br />YOUR RECEIPT <br />THANK YOU <br />5. GRADING <br />DRAINAGE <br />T <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8, HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />SG <br />J <br />ADDRESS FILE <br />IPAIR 82 <br />