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_ "l <br /> 1 <br /> llie E�•erRreen �- J O N ST R U CT I O P' <br /> CITY OF <br /> everett PERMIT PERMIT N0. 12240 <br /> CITY HALL 25987d5 <br /> EVERETT,WA9B201 � COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNER MRILlDORE55 GITY ZIP PHONE <br /> JOYCE SARIWELL 319 CROWN DRIVE EVERETT 98203 252-3980 � <br /> RPGHRECT Ofl OESIGNER MAIL AOORE55 CITY ZIP PHONE <br /> GENERALCONTP�GTOR MAILAO�RE55 GITY ZIP PMONE LICENSE� <br /> Owner <br /> MECHANICAL GONTRRCTOP MAIL A�DRESS CITY ZIP PNONE LICENSE t <br /> PLUMBING GONTPACTOP MAIL RODRE55 CITY ZIP PNONE UCENSE/ <br /> � <br /> � CUSS OF WORK <br /> ❑NEW ❑ADDITION ❑ ALTERATION X�]REPAIR ❑ OEMOLITION ❑ FENCE O SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br /> VALUATION OF WOPN <br /> S �rJ00.�0 <br /> DESCRIBE WORK <br /> Reroof - composition <br /> PNOPOSEO USE OF BUiLDING <br /> Residence 1 HEREBY CERTIFY THAT 1 HAVE REA�AND EXAMINED THIS <br /> APPI.ICATION AND KNOW THE SAME TO BE TRUE AND <br /> IEGRlUESCRIPTiONOFPROPERTY�5MOW8ELOWOHATfACNFOURCOPIE51 CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �or_e�ocK_oF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WI�fH <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERMIT DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOFMANCE OF CONSTRUCTION. <br /> JOB FDDRESS SIGNATURE OF CONiRACTO OR AUTNORRE�FGENT OATE <br /> 319 Crown Drive X � ,,,_ �„� � 7/21/83 <br /> , � <br /> PLUMBING M ANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATERCLOSETQOILET) AIR COND.UNITS— H.P, EA. <br /> BATMTUB flEFRIGERATION UNITS— H.P.EA. <br /> LAVATCRY�WASHBASIN� OUILEftS—H.P. EA. _ <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK 8 OISP. FORCEO AIR SYSTEMS— B.T.U. M EA . <br /> DISHWASHER YlALL HEATERS— B.T.U. M <br /> LAUNDRYTRAY UNIT HEATERS— B.T.U. M <br /> CLOTHES WASMER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTMES ORYERS <br /> URINAL V[NTILATION FAN <br /> DRINKING FOUNTAIN RANGE MOOD <br /> FLOOR DRAIN AIR HANOLING UNIT— C.F.M. <br /> VACUUM BREAKEPS STOVE—WOOG <br /> ROOF ORAINS— RAINLEADERS METAL FIREPLACE 8 CMIMNEY <br /> SINK(SERVICE—BAR,ETC.) FlfiEPLACE INSERT <br /> HEAT PUMP <br /> SUB TOTAL SUB TOTAL S <br /> PEflM1T f PEPMIT S <br /> TOTAL FEE f TOTAL FEE f <br /> SIDE YAR�SETBACK STREETSEiBACK REAR VARD SETBACK PLAN CMECK NUMBER PLAN CMECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> :-:VES GNO F°ES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDIN� $1500.00 .QQ� <br /> SIZE OF�LDG. NO.OF STORIES MAX.OCC.LOAD -- <br /> PLUMBING <br /> FIRE ZONE BASEMENT fIRE SPRINKLERS MECMANICAL �! <br /> REOUIRED <br /> � f.VES ,-_NO <br /> APPROVRLS BY DATE �TMER <br /> 1.ENVIRONMENTAL CHECK LIST PENALTY U.B.C. <br /> SEQ 903(a) <br /> 2.BUILDINGPLANS Z5 OO <br /> 3.FIRE HYDRANT TOTAL <br /> d.FIRE PROTECTION SYSTEM PERMIT VALIDATION <br /> 5.GRADING WMEN PROPERLY VALIOATED�1N THIS SPACE)THIS(I�S YOqURC PERMIT � <br /> 6.ORAINAGE 9 5 9 5 + O L J. O O ����� �-' <br /> 7.ENVIRONMENTALIMPACTSTATEMENT N <br /> 8.HEALTH DISTRICT <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY YO U R R E C E I PT`� <br /> 'il-fANK 1'OU <br /> ADDRE55 FIIE � � � o� <br /> � <br />