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, <br /> �heCvergreen " CO"1STRUCTION -� <br /> CITY OF <br /> everett PERMIT pERMIT NO. 0�556 <br /> CITY HALL 259�8745 <br /> EVERETT,WA 98201 ❑ COMBINATION tE3t BUILDING ❑ MECHANICAL ❑ pLUMBING <br /> OWN.`R MAILAODRE55 CITY piP PMONE <br /> Lloyd A. Peterson 5501 College Avenue 353-1695 <br /> ARCNITECi OR D[SIGNCB MAIL qpDPESS �IiV ZIP PHONE <br /> GENERAL GONTRALTOR AIAIL ADOPES$ pRY IIP PNONE UCENSE� <br /> Same <br /> MECHANICALCON'�V.CTOq �IqILA0DRE55 GI7Y ZIP PMONE LICENSEI <br /> PLUMBINGCANiNACTOR MAILA�DRE55 QTY ZIP PHONE IIGENSEI <br /> CV SS OF WORK <br /> ❑NEW ❑ADDITION ❑AL7ERATION x�]REPAI(7 ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> VALUAiION OF WORK <br /> E 1SOO.00 <br /> DESCFIBE WJRK <br /> re-roof House, garage, shed -- Composition <br /> PROPOSED USE OF DUILDING <br /> single family residence I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AF• <br /> LEGAlDESCRIP110NOFPpOPERiY�SHOWBftOWONATTACNFOURCOPIE$1 PL�CATIUN AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> 11 Fairview ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> ior e�ocK_oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING 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 UR THE PERFORMANCE OF CONSTRUCTION. <br /> JGBADD9ESs College Avenue SiGNATUFEOFCONTRF UR Uil RIZEDAGEN7 DPiES��I�SO <br /> 77U1 <br /> X � <br /> PLUMBIN6 M H N AL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIR COND.UNITS—HP.EA. <br /> BATHTUB REFRIGERATION UNITS—H.P.EA <br /> L4VATORY p4ASH BASIN) BOILERS—HP.EA. <br /> SHOWER GAS FIRED A.C. UNITS—TONNAGE EA <br /> KIICHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISH\NASHER LYALL HEATERS—B.T.U. M <br /> LAUNDRYTRAY UNRHEATERS—B.T.U. M <br /> CIOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN RANGE HOOD ' <br /> FLOOR ORAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOP DRAINS—RAINLEADERS METAL FIREPLACE 8 CHIMNEV <br /> SINK�SERVICE—BAq,ETC.) <br /> SUB TOTAL SUBTOTAL f <br /> PENMIT S PEPMIT f <br /> TOTAL FEE S TOTALFEE t <br /> SIDE YARD SEiBACK STREET SETBACK REAR VARD SETOACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> ❑VES ❑NO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING $ 1500.00 15 00 <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC.LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS <br /> FEOUIRED MECHANICAL <br /> ❑YES ❑NO <br /> APPflOVALS BY DATE OTHER <br /> 1. ENVIRONMENTAL CHECK LIST pENALTY U.B.C. <br /> 2. BUILDING PLANS SEC.303(a) <br /> 3. FIRE HYDRANT TOTAL ^` <br /> 1$ 00 <br /> 4. FIRE PROTECTION SYSTEM PEHMIT VALIDATION <br /> WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING t, <br /> 6. DRAINAGE I g 3 Y S O ( S. O O �� <br /> 7. ENVIRONMENTAL IMPACT STATEMENT . � <br /> B. HEALTHDISTRICT YOUR RECEIP7� <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY - � � <br /> . TIiANK YG�U <br /> - ] uaY 8 O <br /> ADDRESS FILE <br />