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n.e,.•L.I.T.» ^,ONSTRUCTIOV <br />everett PERMIT PERMIT NO. 12251 <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 ❑ COMBINATION BUILDING UtxMECHANICAL ❑ PLUMBING <br />OWNER <br />MALL ADDRESS <br />LITY <br />ZIP <br />PHONE <br />Bruce Gentry <br />5702 East Drive <br />Everett <br />982)3 <br />353-5852 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />L1AIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE Y <br />S:_me <br />CITY <br />21P <br />PHONE LICENSE Y <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE Y <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CLASS OF WO ❑ <br />RK <br />NEW ❑ADDITION 1(1: ALTERATION El REPAIR ❑ DEMOLITION ❑FENCE ❑SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />$ 100.00 <br />v <br />Instaii W000 Stove aNu iva�.aii <br />PROPOSED USE OF BUILDING <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />I HEREBY <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW O -ATTACH <br />FOUR COPIES) <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT_BLOCK_OF <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATII•JG CONSTRUCTION OR THE <br />PERFO ANCE OF CONSTRUCTION. <br />SIGNATU OF CONTRAC OAl OR Ate' `NURIZED AGENT CATE <br />JOB ADDRESS <br />7/25/83 <br />5702 East Drive <br />PLUMBING <br />MECHANICAL <br />NO <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS - H.P. EA. <br />REFRIGERATION UNITS - H.P. EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS - H.P. EA. <br />GAS FIRED A.C. UNITS - TONNAGE EA, <br />SHOWER <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />WALL HEATERS - B.T.U. M <br />DISHWASHER <br />UNIT HEATERS -B.T.U. M <br />LAUNDRVTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT - C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE - WOOD <br />METAL FIREPLACE & CHIMNEY <br />ROOF DRAINS - RAINLEADERS <br />SINK (SERVICE - BAR. ETC( <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL $ <br />SUB TOTAL <br />$ <br />PERMIT $ <br />PERMIT <br />$ <br />TOTAL <br />FEE $ <br />TOTAL FEE <br />$ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />PLAN CHECKFEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />uYES ❑NO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNIT:. <br />BUILDING <br />$100.00 <br />10 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />SPRINKLERS <br />MECHANICAL <br />7 <br />SO <br />RIEQUIRED <br />OTHER <br />YES NO <br />APPROVALS <br />BY <br />DATE <br />U.B.C. <br />1. ENVIRONM NTAL CHECK LIST <br />PENALTY <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />17 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTE N SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THI^,Z $PiJ) THIStS�YJU�PLgR�1T— <br />C\' <br />YO.0 R RECEIPT <br />1 •t ` 1 <br />"IAI V V YOU <br />THANK <br />-t DRAINAGE (i: 4 l <br />7. ENVIRONMENTALIMPAOFETATEMENT <br />. HEALTHDISTRICT <br />r <br />APPLICATION ICC. BY <br />C✓J <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />- < L % <br />J'1 <br />1 l <br />1 <br />�N O m <br />c -D <br />J�L ADDRESS FILE <br />