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Q <br /> die Evergreen rONSTRUCTION <br /> CITY OF <br /> everett PERMIT PERMIT NO. 091�2 <br /> CITY HALL 259�87A5 <br /> EVER[TT,WA 98201 ❑ COMBINATION ❑ BUILDING � MECHANICAL PLUMBING <br /> OWNER MAILNDOPE55 Cliv 21P PHON6 <br /> Joseph & Jewell I. Jordan 23627 - 150th SE Monroe WA 98272 794-8912 <br /> ARCHIiECTORDE5IGNEF MAIIAD�PE55 GTY ZIP PNONE <br /> GENERALCONTRFCTOR MAILAOOPESS CITY 21P PlIONE IIGENSE♦ <br /> Owner <br /> AIECHANICALCONTPAGTOR MAILADDPESS CITY ZIP PHONE UCENSEI <br /> PLUMDING CONTPAGiOR MAII A�UPE55 GI1V ZIP PHONE UCENSE I <br /> CLASS OF WORtt <br /> �JEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> VALUAiION OF WORK <br /> E <br /> DLSCRIBE WONK <br /> Freestanding wood stove <br /> PROPOSED USE OF BUILDING <br /> Residence I HEREBY CERTIFY THAT I IiAVE READ AND EXAMINED THIS AP- <br /> IEGAt OESCRIPTION OF PPOPERTV ISHOW BELOW OF A1TA�H FOUR GOPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS <br /> ior e�ocK_oc TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITI'TO VIOLATE OR CANCEL THE PRO� <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> Si ��iUR@ OF CON1P CiOR 0 AUiHQ IZEO AGENT DA7E <br /> o�A9345Mukilteo Blvd, Everett �• 4/10 81 <br /> PLUMBING MECH ICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER ClOSET(fOILET� AIR CUND.UNIiS—H.P.EA. <br /> BATMTUB HEFRIGERATION UNITS—H.P.EA <br /> LAVATORY pVASH BASiN) BOILERS—H.P. EA. <br /> SHOWER GNS PIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTE�dS—B T.0 Id Ll.. <br /> DISHIVASHER WALL HEATERS—B.T.LL M <br /> IAUNDRY TRAY UNIT HEA7ER5—BT.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLtRS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTIlATION FAN <br /> ORINK�NG FOUNTAIN RANGE HOOD <br /> FLOOR�RAIN AIR HANOLING UNIT— QF.M. <br /> VACUUM BREAKERS ' STOVE <br /> ROOF DF7�INS—RNINLEADERS IdETAL FIREPLACE 8 CHIMNEV <br /> SINK�SEFVICE—BAR.ETC.) � W r <br /> SUBTOTAL SUBTOTAL S <br /> PERMIT S PERMIT S <br /> TOTALFEE S TOTAL FEE 5 <br /> SI�E�ARD SE7BACK STREET SE78ACK REAR YARD SET�ACK PUIN CMECK NUMBER PLAN CHECK FEE <br /> FLE RECEIPT N0. <br /> USE ZONE LOT AFFA VACANT SITE <br /> ❑YES I.1N0 FEES VALUATION F[E <br /> TYPE OF CANST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUIL�ING S <br /> SIZE OF BLDG. NO.OF STORIES MA%.OCC.LOAD <br /> PLUM6ING <br /> FIRE ZONE BASEMENT R OUIRED KLERS MECHANICAL 14 50 <br /> 17VES ❑NO —' <br /> APPROVALS BY �AIE OTHER <br /> L ENVIRONMENTAL CHECK LIST pENALTY U.B.0 <br /> SEC.3091a) <br /> 2 BWLDINGPLANS <br /> TOTAL <br /> 3. FIRE HYDRANT <br /> n. FIfiE PROTECTION SYST[M PERMIT VALIDATION <br /> WHEN PI70PERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING n '1 [ � <br /> 6. DRAINAGE � � �; � �� II I y. J C �� <br /> 7. ENVIRONMENTAL IMPACT STAT[MENT � <br /> 8. NEALTM DISTFICT „O <br /> - } � . � I�� <br /> dPPLICATION ACG BY PLANS CHECKED DV APPR.FOR ISSUANCE BY � . . , . . • <br /> UC ' <br /> . . , \ '���'�, �� <br />