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�he Ll'c�,Crce�t -� ,p N ST R U CT I O P' <br /> everett I P�RMIT PERMIT N0. 16216 <br /> GTV HALL 259�8745 <br /> EVERETf.WA98201 � COMBINATION � 6UILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNER MAIL ADDRE55 CITY ZIP PMONE <br /> EARL BURKEY 4914 DELAWARE EVEETT WA. 98203 25A-iA6H <br /> ARLMITECT OR OESIGNER MAIL ADDFESS l'TY 21P PNONE <br /> GENERALCONTflACtOR MAILADOBE55 CITY Z�P PNONE UtL.':Sc• <br /> CHRIS D10BLEY 3731 108th P1 G F FVFr:Fmm wn 4R�n4 334 �034 <br /> MECMANICAL GONTRACTOR MAIL ADDRESS CRY 21P PMONE LILENSE 1 <br /> PLUMBING CONTRAGTOP MAIL PDDRESS CITY 21P PMONE UCENSE� <br /> L1A550F WORK <br /> ❑ NEW ❑ ADDITION �I ALTERATION ❑REPAIR ❑ OEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br /> VALUATION OF WORK <br /> �U00.00 <br /> �ESCRIBE WORK <br /> Z <br /> O <br /> PROPOSED USE OF BUILOING —i <br /> I HEREBY CERTIFY THAT I HAVE READ AND CXAMINED THIS .. <br /> rAapouT APPLICATION AND KNOW THE SAME TO BE TRUE AND m <br /> LEGFLDESGRIPTIONOFPROPEHTY�SMOW6ELOWOflATTACMFOURCOPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES •• <br /> LOT_BIOCN__OF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH M M <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A _� � <br /> PERM!T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE ,� � <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR �n x <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE o <br /> PERFORMANCE E�ONSTRUC ION. m o <br /> JOBADDRE55 SIGNATUF CTOROR GENT UATE (� <br /> X � m <br /> PLUMBING MECHANICAL i -Zi <br /> m <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE A = <br /> WATERCLOSET�TOILEp AIR COND.UNITS- H.P.EA. C <br /> BATH7UB REFRIGERA710N UNITS-H.P. EA. r = <br /> � .-.� <br /> LAVATORY�WASH BASIN) BOILERS- H.P. EA. -� N <br /> � <br /> SHOWER GAS FIRED A.C.UNI7S-TONNAGE EA. � <br /> KITCHENSINK6015P. o p <br /> FORCED AIR SYSTEMS- B.T.U. M EA. '�1 3 <br /> DISHWASHER WFLL HEATERS- B.7.U. M = m <br /> LAIINDRYTRAV UNIT HEATEFS- B.T.U. M m "' <br /> N <br /> CLOTHES WASHER EVAPORATNE COOLERS � <br /> or <br /> WATER HEATER CLOTHES DRYERS C N <br /> URINAL VENiILATION FAN m N <br /> DRINKING FOUNTAIN RAN3E HOOD � r <br /> FLOOR DRAIN AIR NANDLING UNIT- C.F.M. • m <br /> VACUUM BREAKERS STOVE-WOOD n <br /> A <br /> ROOF DRAINS- RAINLEADERS METAL FIREPLACE 8 CHIMNEY "'� <br /> 2 <br /> SINK(SERVICE- BAR, ETC.) FIREPLACE INSERT n <br /> z <br /> HEAT PUMP ,� <br /> 2 <br /> _ N <br /> Z <br /> O <br /> SUB TO7AL a SUd TOTAL S ""� <br /> PERMIT S PERMIT 5 n <br /> m <br /> TOTAL FEE S TOTAL FEE F � <br /> SIDE VARD SETBAGK STREET SETBACK�REAR YARD SEiBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE 20NE LOT AREA VACi.Ni SITE <br /> �. :VES ' :NO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF OWELLING UNITS <br /> Bl11LDING S � <br /> 512E OF BLDG. NO.OF STORIES MA%.OGC.LOAO <br /> PLUMBING <br /> FIRE 20NE BASEMENT FIRE SPRINKLERS MECHANICAL <br /> REOUIRED <br /> YES NO <br /> APPROVALS BY DA7E OTHER <br /> 1.ENVIRONMENTAL CHECK UST PENALTY U.B.C. <br /> SEC.303(a) <br /> 2.BUILDING PLANS <br /> 3.FIREHYDRANi TOTAL 3B SO <br /> d.FIFiE PRO7ECTION SYSTEM PERMI7 VALIOATION <br /> 5.GRADING H'HEN PROPERLY VALIDATED pN TH�S SPA2E)THI CIS YOUR�RaMIT' � <br /> 6.DRAINAGE } �� � � <br /> N <br /> 7.ENVIRONMENTALIMPACTS7A'EMENT �� <br /> B.HEALTHi]ISTRICT . � � <br /> APPLICATION ACC. BY PLANS CHECKED BY APPR. FOR ISSUANCE BY . �• ��� � ..� I � � <br /> � . •� I <br /> STG JEF LC <br /> � .. ' ..i �. � <br /> ADDRESS FIL[ <br />