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Me Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 <br />CONSTRUCTION <br />PERMIT PERMIT NO.O�982 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />(' DOUGLAS W. & CARMELLA R. HAJEK 6026 DEXTER 98203 355-1945 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />J. CROSS DESIGN GEN. CONTR. 423 TAMERACK EVERETT 98203 353-8010 <br />GENERAL 96NTFIACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE # <br />30 <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHO'.E LICENSE# <br />❑NEW E�,ADDITION ❑ALTERATION ❑REPAIR El DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />f____ __ <br />ADDITION <br />PROPOSED USE OF BUILDING <br />RECREATION ROOM WITH LAUNDRY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />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 />PRESUMETOGIVE AUTHORITY TOVIOLATE ORCANCELTHEPRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE "IF CONSTRUCTION. <br />SIGNAT OF PANT CiOR OR AUi ORI ED AG T DATE <br />X 2 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />16 PLAT OF BEVERLY <br />LOT eLoc _OF <br />HEIGHTS, EVERETT, WA. <br />JOB ADDRESS <br />6026 DEXTER <br />PLUMBING <br />MECHANIC <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />2 <br />0 <br />AIR COND. UNITS - H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA <br />1 <br />LAVATORY (WASH BASIN) <br />2 <br />BOILERS - H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS - TONNAGE EA, <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS - BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS - B.T.U. M <br />CLOTHES WASHER <br />2 <br />00 <br />1EVAPORATIVE COOLERS <br />WATER HEATER <br />2 <br />n n <br />I <br />CLOTHES DRYERS <br />3 <br />1 00 <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />_ <br />SUBTOTAL <br />8 <br />o In <br />SUB TOTAL S <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />S <br />8 <br />U U <br />TOTAL <br />FEE $ <br />3 <br />00 <br />_ <br />SIDE YARD SETBACK <br />5 Feet <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE �' 00 <br />FEES-O Os.S <br />RECEIPT NO. <br />USE ZONE <br />R-2 <br />LOT AREA <br />VACANT SITE <br />DYES XINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />V-N <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />-010- <br />SIZE OF BLDG. <br />x32'Approx. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />3 <br />BASEMENT <br />No <br />FIRE REQUIRED SPRINKLERS <br />DYES LINO <br />MECHANICAL <br />3 <br />00 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC. 303 (a) <br />2. BUILDWG PLANS o� <br />TOTAL <br />59 <br />00 <br />3. FIRE HYDRANT '- <br />4. FIRE PROTECfION SYSTEM <br />-5. GRADING :.. <br />C <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />11 b.Q Q 3 6 4 17 0 48.00 I--0-ji <br />$OU Due On Plan Check F e 00 <br />Cn <br />R C I I PT YOU R RE E I PTo <br />i .� �, „ LiTHANK YOU <br />Kl. DRAINAGE �;.� p <br />I <br />�. ENVIRqqME.WL IMPA FtTATEMENT <br />Xq. HEAL7HSJIgiiACT <br />PPLICATIION � . BY <br />C "9 <br />--I <br />CANS CHECKED BY <br />VIC <br />t <br />APPR. FOR ISSUANCE BY <br />7 <br />0 <br />1 8 AUG 8 0 <br />ADDRESS FILE <br />I <br />8 Aw 80 <br />