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�heEvC�roF C�NSTRUCTION --� ''�� <br /> everett PERMIT pERMIT N0. 10054 <br /> CIN HALL 259�8745 <br /> EVERETf.WA 98201 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ P�JMBING . <br /> OWNER MAILAOUAE55 QTY ZIP PMONE <br /> Irving Sobotka 4912 Forest Drive Everett 98203 <br /> ARCHITECTOROESiGNEP MAILAOOPE55 CITY 21P YMONE <br /> GENEPRL CONTPACiOB MFII AODPESS CtTY ZIP PHONE LICENSE� <br /> Same <br /> MECHANICALCANTW�.IOR MRILADDRE55 CILY ZiP PHONE 4GENSE/ <br /> PLUMBINGCONTNACTO�i MRILAODRESg GITY ZIP PMONE UGENSE� <br /> CLA55 OF WOPK <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑FEPAIR ❑OEMOLIiiON ❑FENCE ❑SIGN ❑GARAGE <br /> VALUATION OF YIORK <br /> S <br /> �ESGRIBE WORK -- <br /> Inatall wood atove <br /> PNOPOSE�USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> LEGA�DESCPiPTIONOFPPOPEFTYISHOW 9ELOWOflNRAGHFJUHfAVIES) PLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS t�ND ORDINANCES GOVERNING THIS <br /> - ior e�xK_oF TYPE OF WORK WILL BE COh7PLIED WITH WHETHER SPECIFIED <br /> � HEREIN OR NOl". THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY 1'O VIOLATE OR CANCEL THE PRO� <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORti!ANCE OF CANSTRUCTION. <br /> SIGNNTURE OF CANTMCTOR Ofl AUTHOPIZED RGENT DATE <br /> � ,p6A�DflE55 <br /> 4912 Forest Drive X 12 2 81 <br /> PLUMBINU MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOU!PMENT FEE <br /> WATER CLOSET(fOILEn AIR COND.UNITS—H P.:A. <br /> BPTHTUB REFRIGERATION UNITS—H.P.EA <br /> LAVATORY(WASH BASIN) BOILERS—H.P.EA. . <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK 6 DISP. FORCED AIR SYST�MS—B.T.U. M EA. <br /> DISNWASHEfl WALL HEATERS—B.T.0 M <br /> LAUNDRYTRAY - UNITHEATERS—B.T.U. M _ _ <br /> CLOTHES WASHER EVAPORATIVE COOLEflS <br /> WATER HEATER CLOTHES DRYERS <br /> . URINAL VENTILATION FAN <br /> . DRINKING f-0UNTAIN FiANGE HOOD <br /> FLOOR�RAIN AIR HAN�LING UNIT— C.F.M. <br /> VACUUMBflEAKERS 1 STOVE WOOd � <br /> � ROOF DRAINS—RAINLEADERS METAL FIHEPLACE 6 CHIMNEY <br /> . SINK(SERVICE—BAF.EfC.) — <br /> SUBTOTAL SUBTOTAL f 7 <br /> PERMR f PENMIT S 10 00 <br /> � TOUL FEE f TOTAL FEE f <br /> SIDE YARD SET&4CK STREET SETBACK REAR YARO SETBACK PLAN CHECK NUMBEF PL4N CHECK FEE <br /> FEE pECEIPT NO. <br /> USE ZONE LO7 AREA VACAN7 SI7E FEES VALUATION FEE <br /> ❑YFS ❑NO <br /> TYPE OF CANS". OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING $ <br /> SIZE OF BLDG. NO.OF STORIES MA%.OCC.LOAD <br /> PLUMBING <br /> FIREZONE BASEMENT qEOUIREDKLEFS MECMP.NICAL 1� SO <br /> ❑YES ❑NO <br /> APPROVALS BY DATE OTHER <br /> 1. ENVIRONMENTALCHECKLIST PENAL7V U.eC. <br /> SEL.303(a) <br /> 2. BUILDING PLANS TOTAL 17 S O <br /> 3. FIRE HYDRANT <br /> 4. FIRE PROTECTION SYSTEM PENMI7 VALIDATION <br /> WHEN PflOPERLY VAIIDATEO(IN THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING � � . �i �.. " I I. r �� _�� . <br /> 6. ORAINAGE �� <br /> 7. ENVIRONMENTAL IMPACT STA7EMENT O <br /> 8. HEALTH DISTRICT . � .:- I a"� <br /> , APPLICATION ACC.BY PLANS CHECNED BY APPR.FOR IFSUANCE BY . . , f <br /> J <br /> _� <br /> ' _� .. I <br /> ADDRESS FILE <br />