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F the Evergreen CONSTRUCTION <br />n0A ANY�oA , . PERMIT �' <br />CITY FALL 259 8.745 <br />f% EE=R t�,stjV�B1 CWTINATION • BUILDING • MECHf NICAL • PLUMBING <br />r. <br />III4e <br />everett <br />OWNER MAIL ADDRESS ZIP PHONE <br />Dallas R. Olson, Jr. P. O. Box 607 Mukilteo, Wn 98275 355-3834 <br />m <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />3 <br />223-01 <br />GENERM-CONTRACOR MAIL ADDRESS PHONE LICENSE NO. <br />Z <br />d L-SO-NO <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />p-) TI <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />CD <br />W <br />~� <br />PERMIT CLASS <br />OF WORK <br />Basic <br />® COMBINATION <br />❑BUILDING ❑PLUMBING []MECHANICAL <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUAT ION OF WORK <br />❑DEMOLISH ❑FENCE ❑SIGN []SWIMMING POOL <br />C <br />$ SO, OOO <br />DESCRIBE WORK <br />' <br />New residence <br />PROPOSED USE <br />MECHANICAL <br />1 <br />TYPE OF ENERGY ❑�-J GAB { ELEC. <br />LEGAL DESCRIPTION OF (ROPE RTV (SHOW BELOW OR ATTACH <br />F O'JR COPIES) <br />FOUR <br />96 Highland estates <br />NO. I <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <br />LOT BLOCK —OF <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />I <br />FORCED AIR SYSTEMS-B.T.V. MEA. <br />5.00 <br />i <br />I <br />R-1-28-4 <br />JOB ADDRESS <br />SPACE & WALL HEATERS <br />UNIT HEATERS-B.T.U. <br />6309 Firwood Place <br />EVAPORATIVE COOLERS <br />PLUMBING <br />1 <br />CLOTHES DRYERS <br />3.100 <br />1 <br />VENTILATION FAN <br />2.00 <br />RANGE HOOD <br />3,100 _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />S <br />I <br />CLOTHES WASHER <br />1 <br />WATER HEATER <br />DISH WASHERS <br />2.100 <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />' <br />SUB TOTAL $ <br />13.100 <br />1KITCHEN <br />SINKS & UISP. <br />� <br />_ <br />PERMIT <br />' <br />BAR SINKS <br />I <br />$ <br />� <br />ROOF DRAINS - RAIN LEADERS <br />I <br />TOTAL FEE S Inn <br />W';SHOWER <br />BATHS <br />2 OO <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />SERVICE SINKS <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OP. IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />_I <br />SUMPS - SEWAGE PUMP <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />URINALS <br />I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />NOT, TIE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUT RITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH STATE O LOW�AONSTRUCTION <br />OR THE P FORM E OF <br />WATER CLOSETS <br />6 100 <br />WATER HEATERS - ELECTRIC <br />2 IOO <br />WASH BASINS <br />6J006 <br />LA'JNDRY TRAYS <br />9OR <br />I <br />I <br />- <br />SUB TOTAL 26.00 <br />PERMIT STOTAL <br />I <br />FEE <br />XWATER <br />SERVICE SIZE BLDG. SUPPLY SIZE <br />sIG n RE OF CONTRA TATE If <br />PLAN CHECK NUMBER PL CHECK FEE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />51 <br />201 <br />201 <br />FEE RECEIPT NO. <br />79/283 Basic <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />R-2 <br />®YES []NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO.OF DWELLING <br />UNITS <br />STORIES <br />BUILDING <br />S 50,000 <br />187J00 <br />SIZE OF BLDG. <br />NO. OF <br />MAX. O C. LOAD <br />PLUMBING, <br />26y00 <br />I 1 <br />- <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED <br />[]YES KIND <br />MECHANICAL <br />13400 <br />3 <br />e8 <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />PENALTY <br />SEC. 3030) <br />I <br />T <br />— <br />TOTAL <br />I <br />226100 <br />a <br />m <br />PERMIT VALIDATION 1. <br />WHEN PROPERLY VALIDAI ED (IN THIS SPACEI THIS IS OUR PERMIT <br />;VCXU;R .RECEIPF) <br />IiiANK YOUu, <br />o <br />m = -- -- <br />ra <br />FIlly <br />IbW.79 <br />B <br />I <br />J.DDRESS FILE <br />