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_� <br /> � �hc£vergreen � �� <br /> ��T�oF � -- �-^ONSTRUCTIO �� " <br /> �� everett pE��IIT PERMIT N0. 1ZJ�78 <br /> CITY HALL 259�8746 <br /> EVERETT.WA 98201 ❑ COMBINATION C�RBUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNER MAILADDflESS GITY 21P PMONE <br /> Charlae P. Hoiqate 4902 Forest Drive L�erett 98203 259-5844 <br /> AP�HITECT Ofl DESIGNER MAIL AODRE55 CITY ZIP PHONE <br /> . GENEFAL CONiRACTOR MAIL ADONESS CRY ' ZIP PHONE LICENSE� <br /> sa�e <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br /> PLUMBING CONTRACTOR MAIL AD7RESS CITY ZIP PHONE LIGENSE� <br /> CLA55 OF WORK <br /> ❑ NEW GEMDDITION ❑ ALTERATION ❑REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br /> VALUATIONOF WORK <br /> f 14���.00 <br /> DESf,pIBE WORK <br /> iro Story Addttioa to existiag residence o <br /> PHOPOSEO USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> �ieqle !'amily Residence AppLICATION AND KNOW THE SAME TO BE TRUE AND �" <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWBELOWORATfACHFOURCOPIES) CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES �� <br /> �or 49 BLOCK_OF ��st Pask GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH ,. .... <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A -� � <br /> PERMIT DOES NOT PRESUME TO GIVE AUTHORIT:TO VIOLATE N= <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR m <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE c o <br /> PERFORMANCE OF CONSTRUCTION. �^� <br /> JOB AD�HESS SIGNATURE OF CONTPA R O U�NORIZED DATE <br /> 4902 lbraet H�ive X /O- �- l�� � m <br /> �z <br /> PLUMBINO MECHANICAL m '�'� <br /> NO. TYPE OF FIXTUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE C Z <br /> WATERCLOSET(TOILEn AIR COND.UNI75- H.P. EA. D � <br /> BATHTUB PEFRIGERATION UNITS- H.P. EA. .r-�� <br /> LAVATORY(WASHBASIN) � N <br /> BOILERS- H.P. EA. < � <br /> SHOWER GAS FIRED A.C.UNITS-TONNAGE EA. O 70 <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS- B.T.U. M EA. � <br /> DISHWASHER WALL HEATERS- B.7.U. M i m <br /> m�-. <br /> LAUNDRYTRAY UNIT HEATERS- B.T.U. M v In <br /> CLOTHES WASHER EVAPORATIVE COOLERS � m <br /> WATER HEATER GLOTHES DRYERS 3 N <br /> URINAL VENTILATION FAN Z � <br /> DRINKING FOUNTAIN RANGE HOOD � m <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. � p <br /> VACUUM BREAKERS I STOVE-WOOD <br /> ROOF ORAINS- RAINLEADERS � METAL FIREPLACE 8 CHIMNEY a <br /> SINK(SERVICE- BAR, ETC.) FIREPLACE INSERT = <br /> HEAT PUMP = <br /> N <br /> 2 <br /> O <br /> SUB TOTAL S SUB TOTAL S �-�+ <br /> PERMIT S PERMIT S m <br /> TOTAL FEE S TOTAL FEE S i <br /> SIDE YARD SETBACK S7REET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> �1 i_VES [� FEES VALUATION <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> � _ BWIDING S 4 00�. ' <br /> SIZE OF BLDG. N0.OF STOFIES MA%.OCC. LOAD <br /> PLUMBING <br /> � <br /> IR Z N BASEMENT FIRESPRINKLERS MECHANICA� <br /> REOUIRED <br /> YES �NO <br /> APPROVALS BY DATE OTHEF <br /> 1. ENVIRONMENTAL CHECK LIST PENAL7Y U.B.C. <br /> SEC.J03(al <br /> 2,BUILDING PLANS <br /> 3.FIRE HYDRANT TOTAL 11 SO <br /> 4.FIREPROTECTION SYSTEM PEHMIT VALI�A710N <br /> 5.GRA�ING WHEN PROPERLY VALIDATED(IN 7HIS SPAGE)THIS IS YOUR PERMIT � <br /> 6.DRAINAGE ~ <br /> 7.ENVIRONMENTALIMPACTS7ATEMENT N <br /> � 8.HEALTH DISTRICT �..� <br /> APPLICATION ACC. BY PLANS CHECKED BV APPR.FOR ISSUANCE BY <br /> 57G HS7M LC <br /> APPLICANT'S COPY <br />