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� 1 <br /> '"eE°�gYeo° -- Ca�1STRUCTION -- ^ <br /> ever�t� P�RMIT PERMIT NO. OH5O6 <br /> CITY HALL 259�8745 <br /> EVEf.ETT.WA 98201 ❑ COMBINATION ❑ BUILDING �)OME�HANICAL ❑ PLUMBING <br /> OWNEF MAILADDRE55 CITY ZIP PHONE <br /> Dennis Courtney 4818 Forest Drive 98203 259-1823 <br /> ARCHITECT OR�ESIGNER MAIL AODRE55 CITY ZIP PMONE <br /> GENERAL CONTRACTOR MAIL A�DflE55 CITV ZIP ✓HpNE LIGENSE/ <br /> MECMANICALLO�YTFACTOR MAILADDRESS GITY ZIP PHONE LICENSE/ <br /> Same <br /> PLUM818G CANTflACTOR MAIL AP�RE55 CITY ZIP PHONE UCENSE� <br /> CLASS Oi WORN <br /> ❑NEW ❑ADDITION ❑ALTERA7IUN ❑REPAIR ❑DEMOLITION ❑FENCE I�SIGN ❑GARAGE <br /> VALUATION OF WOflK <br /> E <br /> OESCRIBE WOflK <br /> install wood stove <br /> PROPOSED USE OF BUIIDING <br /> I IiEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> LEGA�DESI:PIPTION OF PROPERiY�SHOW BELOW OR ATTAGH FOUR WPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �or e�a�oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> 4495-000-050-003 HEREIN OR NOT. THE GRANTIN� 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 PERFOFlMANCE OF CONSTRUCTION. <br /> SIGNATURE OF GONiRACiOR OR FUTHORIZED FGe JT DATE <br /> JOB ADDflESS <br /> 4818 Forest Drive X F 'V.i�� 10 30 80 <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE _ <br /> WATER CLOSET(TOILEf) A�fl COND.UNITS—H.P.EA. <br /> &4THTUB REFRIGERATION UNITS—H.P.EA ' <br /> LAVATORY�WASH BASIN) BOILERS—H.P.EA. _ <br /> SHOWER GAS FIRFD A.C.UNITS—TONNAGE EA � <br /> KITCHEN SINK 8 DISR FOFCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALL HEATERS—B.T.U. M _ <br /> IAUNDRV TRAY UNIT HEATERS—B,T.U. M _ <br /> CLOTHEu WASHER EVAPORATIVE COOLEflS <br /> WATER HEATER CLOTHES DRYEPS <br /> URINAL VENTILATION FAN <br /> � DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN �11R HANDLING UNIT— GF.M. <br /> VACUUM BREAKERS 1 STOVE WOOd <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE 8 CHIMNEY <br /> SINK�SERVICE—BAR,ETGI <br /> SUB TOTAL SUB TOTAL S 4 S O <br /> PERMR S PEHMIT f 3 00 <br /> TOTALFEE f TOTALFEE S <br /> SIDE YARD SETOACK STREET SETBACK REAR YARD 3ETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT�O. <br /> USE ZONE LOT AREA VACANT SITE � <br /> ❑YES ❑NO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING S <br /> SI2E OF BLDG. N0.OF STORIES MA%.OCC.LOAD <br /> PLUMBING <br /> FlFE ZONE BASEMENT REOUIRED KLERS MECHA�;r,;AL <br /> OYES ❑NO _ 7 SO <br /> APPROVALS BY UATE OTHE'1 <br /> 7. ENVIRONME`1TALCHECKLIST pENALTY U.B.C. <br /> - SEC.303(a) <br /> 2. BUILDING PLANS <br /> 3. FIRE HYDRANT TOTAL 7 O <br /> 4. FIRE PROTECTION SVSTEM PENMIT VALIDATION ^ <br /> 5. GRADING WHEN PROPERLY VALIDATED(IN THIS SPAC9E1&kil$.IS YO���,� 5 p —� t{ <br /> 77 � <br /> 6. DRAINAGE - Q <br /> 7. ENVIRONMENTAL IMPACT STATEMENT n � <br /> 8. HEALTH DISTRICT ` � �)i �\ "` � �� <br /> APPLICATION ACC.BY PLAN£CHECKEC BV APPR.FOR ISSUANCE RY ., :'{�����!^ ���� � <br /> ° � � aCi 80 <br /> ADDRESS FILE <br />