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� <br /> d�c [rer,�rren <br /> ��T°°F ' -� CONSTRUCTIC'V <br /> everett PERMIT PERMIT NO. 1295� <br /> CITY HALL 259�87d5 � <br /> EVERETT,WA 98201 ❑ COMBINATION � BUILDING G MECHANICAL ❑ PLUMBING <br /> UWNER MAIL ADpRE55 CIiY 21P PMONE <br /> JOHN R. CAIN 520 - 107th P1 SW Everett WA 98204 355-8968 <br /> ARCHITECT OR DESIGNER MnIL ADDRESS pTY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS GITV ZIP PMONE LICENSE N <br /> Same <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE M <br /> PLUMBING CONTRACTOR MAI�AOORESS CITY ZIP PNONE LICENSE� <br /> CLA55 OF\YORK <br /> ❑ NEW O ADDITION ❑ ALTERATION �REPAIR ❑ DEMOLI710N ❑ FENCE ❑ SIGN ❑ WOOD STOVFJFIREPLACE INSEFT <br /> VALUATION OF WORK <br /> sts,000. <br /> DESCRIB�WORK <br /> Fire damage repair <br /> PROPOSED USE OF BUILDING <br /> Residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINE�THIS <br /> LEGAL OESLNIPTION OF?ROPERTY�SMOW BELOW OR ATTACH FOUR COPIES� APPUCATION AND KNOW THE SAME TO BE TRUE AND <br /> CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �or7&8 BLOCK 633 oF Everett Div I GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHER SPECIFIED HEREIN OF 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 REGU�ATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. <br /> JOB ADDRESS SIGNATURE OF CONTRACTOR OR AUTNORI2ED AGENT DATE <br /> 2412 Everett Ave X � 2 2 84 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE 07 ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILEn AIR COND. UNITS— H.P. EA. <br /> BATIITUO REFRIGERATIUN UNITS— H.P. EA. <br /> LAVATORV(WASH BASIN) BOILERS — H.P. EA. <br /> SHOWER GAS FIRED A.C.UNITS —TONNAGE EA. <br /> KITCNE4 SINK 8 DISP. FORCED AIR SVSTEMS— B.T.U. M EA. <br /> DISHSVASHER WALL HEATERS— B.T.U. M <br /> LAUNDRV TFAI' UNIT HEATERS— B.T.U. M <br /> CLOTMES WASHEA EVAPORATIVE COOLEfiS <br /> WA7ER MEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUN7AIN RANGE HOOD <br /> FLOOR ORAIN Alq HANDLING UNIT— <br /> C.F.M. <br /> VACUUM BREAKERS STOVE —WOOD <br /> ROOF DRAINS— RAINLEADERS METAL FIREPLACE 8 CMIMNEY <br /> SINK(SERVICE— BAR, ETC.) FIREPLACE INSERT <br /> HEA7 PUMP <br /> SUB TOTAL i SUB TOTAL S <br /> PENMIT S pERM1T S <br /> TOTAL FEE S TOTAL FEE S <br /> SIDE YARDSE78ACK S7REET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CMECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> �.:YES i�NO FEES VALUATION FEE <br /> 7YPE OF CONST. OCCUPANCV GROUP NO.OF DWELLING UNITS <br /> BUILDING $ <br /> SIZE OF BLDG. N0.OF STORIES MAX.OCC. LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLENS MECHANICAL <br /> RE�UIRED <br /> i ;VES ;:NO <br /> APPHOVALS BY OATE OTHER <br /> 1.ENVIRONMEN7AL CHECK LIST PENALTY U.B.C. <br /> 2.BUILDING PLANS SEC.3031a) <br /> 3.FIRE MYDHANT T�TA� ��O 5O <br /> 4.FIRE PROTECTION SYS7EM PERMIT VALIUATION <br /> 5.GRADING WHEN PROPERLY VALIDATED pN THI�SPl�,C�THIS�S�O�IF�P��y�IT_� <br /> 6.DRAINAGE S � � I U U <br /> 7.ENVIRONMENT4LIMPACTSTATEMENT Cn <br /> 8.HEALTH DISTRIC7 p � <br /> APPLICATION ACC. BY PLANS CHECY.ED BY APPR. FOR ISSUANCE BV �� � . � . I\EC r I PT t��� <br /> DAB "; ' {,^P.!K �i:` U <br /> - � ri'� uy <br /> ADDRESS FILE <br /> � <br /> i <br />