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everett PERMIT � <br /> I;ITY HALL 259�8745 <br /> PERMIT NO. OH786 <br /> EVENETT,WA 98201 ❑ COMBINATION '�BUILDING ❑ MECHANICAL ❑ PLUMBING � <br /> � <br /> 01YNER MAILAUDRESS CITY ZIP PMONE <br /> James Bustad 4511 Crescent Drive, Everett 98203 252-3000 <br /> AHCMIiECi OR DESiGNFR MAIL AOORESS CITY ZIP PHONE <br /> GENERAICONTRACTOq MAILAC�RESS qiY ZIP � PNONE LICENSE♦ <br /> Owner <br /> IAECHANICFLCONTRACTOR MAILADDFESS dTY ZIP PHONE LICENSEI <br /> PLUMBINGG@ITRACTOR MAILADDRE55 CITV ZIP PHONE IICENSEI <br /> CLA55OF WORK <br /> ❑NEIN ❑ADDI710N ❑ALTERATION x�]REPAIR ❑DEAIOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> VALUATION OF WORK <br /> 5 1SOO.00 <br /> DESCRIBE\YOPK <br /> New roof <br /> f'FOi'OSED USE OP BUILDING <br /> Residence - single family I HEREBY CERTIFY 7HA7 I HAVE READ AND EXAMINED THIS AP- <br /> LEGALDESCRIPTIOPpFPROFERiY�SM0IVBEL01Y0RAiTACHFOURGOPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> LOT�_BLOCI(�4_OF ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> 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 CANC[L THE PRO- <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONS�RUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> J0�AO�RESS S'GNl�U E OF LONiRACTOR OR AUTHORIZED AGEKT � pAiE <br /> 4511 Crescent Drive, �erett ' <br /> X i �[�.�..i' . � -. l�J��.t��s.rG� 1/19/61 <br /> PLUMBING hA� ANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE 0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET 1701LET) nIR CO�JD.UNITS—H,P.EA. <br /> BATHTUB REFRIGEFATION UNITS—H.P.EA <br /> LAVATORY�WASH NASIN) BOILERS—HP.EA. <br /> SHOWER GAS FlRED A.C.UNIiS—TONNAGE EA. <br /> KITCHEN SINK 8 DISR FORCED AIR SVSTEMS—B.T.U. M EA <br /> OISHWASHER WALL HEATERS—BS.U. M <br /> _ IAUNDRY TRAY UNIT HEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANULING UNIT GF.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAINIEADERS METAL FIREPLACE&CHIMNEY <br /> SINK ISERVICE—BAR.ETQI <br /> SUB TOTAL SUBTOTAL f <br /> PERMIT 5 PEHMIT S <br /> TOTALFEE S TOTAL FEE S <br /> SIDE VARD SETBACK STPEET SETBACK REAR YARD SETBACK PU1N CHECK NUMBER PL1N CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> GVES ❑NO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> 6t,�LDING 5 1800.00 29 0 <br /> SIZE OF BLDG. N0.OF STORIES MA%.OCC.LOAD <br /> P�UMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS <br /> REOUIRED MECHANICAL <br /> ❑YES ❑NO <br /> APPROVALS BY DATE OTHER <br /> 1. ENVIRONMENTAL CHECK LIST PENALTY U.B C. <br /> 2. BWL�INGPLANS SEC.3031a) <br /> 3. FIREHYDRANT TOTAL Zcj � <br /> a. FIRE PROTECTION SYSTEM PEflM1T VALIDATION <br /> WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING <br /> 6. DRAINAGE � <br /> � <br /> 7. ENVIRONMENTAL Ih1PACT STATEMENT � <br /> e. HEALTH DISTRICT � <br /> APPLICATION ACC.BY PLANS CHECNED BV APPR.POR ISSUANCE BY � �i �� O $ 0 2 9. 5 U O � <br /> � � R!:�. ;:IPT <br /> ADDRESS FILE � � ' � <br />