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the Evergreen <br />CITY OF <br />G J N STR U CTI O N <br />I <br />everett <br />PERMIT <br />PERMIT NO.•11OZZ <br />CITY HALL 259.8745 <br />EVERETT. WA 98201 ❑ COMBINATION ❑ BUILDING MECHANICAL <br />❑ PLUMBING <br />OWNER <br />JAMES P. MOOS <br />MAIL ADDRESS CITY <br />6307 Firwood Place Everett <br />ZIP PHONE <br />98203 353-9649 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ApORESS CITY <br />ZIP <br />PHONE LICENSE( <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />Same <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE LICENSE # "} <br />CLASS OF WORK <br />XXNEW ❑NDDITION <br />❑ALTERATION ❑REPAIR [-]DEMOLITION ❑FENCE <br />LJSIGN ❑GARAGE <br />VALUATION OF WORK <br />E <br />DESCRIBE WORK <br />Install wood stove <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 CAACEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAfUN OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 9/17/82 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT —BLOCK —OF <br />JOB APURESS <br />6307 Firwood Plate <br />PLUMBING <br />MECHANICAL <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 2. DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />I 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 <br />ROOF DRAINS — RAINLEADEHS <br />METAL FIREPLACE 8 CHIMNEY <br />SINX(SERVICE — BAR. ETC.) <br />_ <br />_ <br />Wood stove <br />SUBTOTAL <br />SUBTOTAL $ <br />7 <br />PERMIT S <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL <br />FEE S <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 ❑NO <br />FEES <br />VALUATION <br />CEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <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 />OYES ONO <br />MECHANICAL <br />17 <br />S O <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 />17 <br />50 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT <br />7690 $ 017.50 --tN 4 <br />Q <br />.-4 <br />YOUR •REC E I PTi <br />THANK YOU <br />5, GRADING <br />6. DRAINAGE <br />7, ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKFD BY <br />APPR. FOR ISSUANCE BY <br />I <br />ADDRESS FILE ? 0 SEP 81 <br />