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- 'l <br /> 1 <br /> dieErcrgrcen �- ^,ONSTRUCTIOI�' <br /> Giv OF <br /> everett PERMIT PERMIT NO. 121HO <br /> CITY HALL 259�0745 <br /> EVERETT,WA 98201 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWhER MAIL ADDRE55 CITY ZIP PHONE I <br /> William R. Rose 6607 Commerciat avP 98203 353-3488 _ <br /> �PCHITECT OR OESiGNER MAIL�D�RE55 CITY ZIP VMONE <br /> GENEHRL(:ONiRAGTOP MRILADORE55 CITY ZIP PMONE LICENSE� <br /> Same <br /> MEGHRNICRL CONTRACTOR MAIL qODRESS ��TY 21P PHONE IICENSE� <br /> i � <br /> PLVMBING GONTRAGTOP MAIL pDDPESS CITV ZIP �'MONE LIGENSE/ <br /> CUSS OF WORR <br /> O NEW O ADDITION ❑ ALTERATION �EXREPAIR ❑ D[MOLITION O FENCE ❑ SIGtJ O WOOD S�UVFJFIflEPLACE INSE!1T <br /> VALUATION OF WOPN <br /> S 1700. 00 <br /> OESCRIBE 1VORK <br /> Re-roof composition <br /> PROPOSED USE OF OUIl01NG <br /> Single Family REsidence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAL�ESCRIPTIONOFPROPEHtY�5H01V8ELOWONATfFCMFOURGOPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �or5�6 BLOGK 6 aF Pinehurst GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> 5447-006-005-0002 PERMIT DOES NOT PRESUMF.TO GIVE AIiTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. <br /> JOB A��PE55 SIGNA E OF COI:T CTOR�AUTNOR12E0 AGENT �r1TE <br /> 6607 Comme i X , 7/8/83 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) AIR COND.UNITS—H.P.EA. <br /> BATMTUB 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 8 DISP. FORCED AIR SVSTEMS— B.T.U. M EA. <br /> DISHWASMER WALL MEATERS— B.T.U. M <br /> LAUNOflY TRAY UNIT HEATERS— B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER MEATF.R CLOTHES ORVERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM 9flEAKERS STOVE—WOUO <br /> ROOF DRAINS— RAINLEADEflS AfETAL FIREPLACE 8 CHIMNEY <br /> SINK(SERVICE— BAR,ETQ) FIREPLACE INSERT _ <br /> HEAT PUMP <br /> SUB TOTAL i SUB TOTAL 5 <br /> PEHM�T S PERMIT S <br /> 10TALFEE f TOTAL FEE S <br /> SIOE YARD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CMECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> FEES VALUATION FEE <br /> CYES :::NO <br /> iYPE OF Cf�NST. OCCUPANCY GROUP NO.OF OWELLING UNITS <br /> BUILDuaG S17OO. 2B OO <br /> SIZE OF BLDG. N0.OF STORIES MA%.OCC.LOAD <br /> � PLUMBING f <br /> .._t <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS MECHANICAL <br /> qEOUIRED <br /> �.-_YES CNO <br /> APPROVA�S BY �ATE OTHER <br /> 1.ENVIRONMENTAL CHECN L15T PENA�T� U.B.C. <br /> SEC.J09�a) <br /> 2.BUILDINGPLANS TOTAL 28 00 <br /> 7.FIRE MYDRANT <br /> �� d.FIREPROTECTI0N5YSTEM �ERMITVALIDRTION <br /> S.GRADING YJMEN PROPEHLY VALIDATED�IN TI�SIS�l�E)THIF I���i P�aM1T Q <br /> y c a a uu u <br /> 6.DRAINAGE � <br /> 7.ENVIRONMENTAL IMPACT STATEMENT (V <br /> B.MEALTH�ISTRICT YOUR RECEIPT `� <br /> APPLICATION ACC.BY PLANS CHECKED BV APPR.FOR ISSUANCE BY <br /> ri-�nNK You <br /> 11 �. 83 <br /> ADf�RES'� PILE <br /> ..� <br />