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the Evergreen <br />CITY OP <br />, <br />� C',NSTRUCTION <br />everett PERMIT PERMIT NO.O6H72 <br />GTY HALL 259�8745 <br />EVERETT. WA 98201 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑,PLUMBING <br />OWNER MNIL ADDflESS CITY ZIP �NONE <br />_1�.D R�ckett� 6��i FlPmina u� FcPrn++ aa�p3 353-143d <br />ANCHiTECi OR DESIGNER MAIL AOORESS GTY nr rnurvt <br />Self <br />GENERAL CANTflACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE / <br />Self <br />MECHANICAL fANTRACTOR MAIL AOORESS CITV 21V PHONE LICENSE / <br />None <br />PLUMBING CONiRACTOR MAIL AO�PE55 GITY 21P FMONE UCENSE / <br />C1A550F WOPK <br />❑NEW �ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLI710N ❑FENCE ❑SIGN ❑GARAGE <br />VFLU4TION OF YJOFK . • <br />E 1�0�.00 <br />DESCRIBE WOPK <br />PROPOSED USE OF BUILOING <br />storacre of la <br />LEGAL DESCF�PTION OF PROPEPTY � <br />�or 35 e�x�oF . <br />� <br />PLUMBINO <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BAS:N) <br />SHpyyER <br />KITCHEN SINK 8 DISP. <br />DISHWASHEF. <br />LAl1NDRY TRAY <br />0 <br />� <br />SIDE VARD SETBACK <br />TYPE OF CANS <br />V—N <br />SIZE OF BLDG. <br />lOXZS <br />STREET SETBACK <br />LOT AREA <br />OCCUPANCY GROUP <br />M-1 <br />1. ENVIRONMEN7AL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />fi. DRAINAGE <br />7. ENVIRONMEN7AL IMPACT STATEMENT <br />8. HEALTH DISTRIC7 <br />APPLICATION ACC. BY PLANS CHECKED BV <br />REAR YARD 5 <br />VACANT SITE <br />❑YES ❑NO <br />NO. OF DWEL <br />MAX.00C.LC <br />FIRE SPRINKL <br />REOUIRED <br />OYES ❑NO <br />aT <br />APPR. FOR ISSUANCE BY <br />I HEREBY CERTiFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TR;:E 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 AUTHORIT'Y TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFGRMANCE OF CONSTRUCTION. <br />SiGNATUREOFCONiRACTOROBfUTHORIZ[D'ntiENT DATE <br />X iYl�.a .12%�.� e .L� �.� 10-23-79 <br />MECMANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />OND. UNITS — H.R 8A. <br />IGERATIOt! UNITS — H. <br />AS — HP. EA. <br />GAS FIRED A.C. UNI15 — TOI <br />FORCED AIR SYSTEMS — B T <br />WALL HEATERS — 8 T.U. <br />L1NIT HEAT[RS — B.T.U. <br />H000 <br />6872 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />M <br />C.F.M. <br />FEE <br />FEE I RECEIPT NO. <br />$1 <br />U.B.C. <br />SEC. 303 (a) <br />._..._ . _.. <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />39�a tQ t0.A0 �ry � <br />� <br />.You.� a��a�i�o <br />TpiA1�K Y+O'U <br />i <br />