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�. <br /> �,.�, <br /> d�eGvergreen � �ONST'RUCTIOM: , � � <br /> "TYOF PERMIT <br /> everett PERMIT N0. OH7S� <br /> CITY HALL 259�8745 <br /> EVEFETi.WA 9820� � COMBINATiON ❑ BUILDING ❑ MECHANICAL PLUMBING —_ <br /> CITY ZIF PHONE <br /> MAI�ADDRE55 98203 355-3189 <br /> OYMER <br /> Jack M. Henry 1802 Dull Place ctY ZiP P„or+e <br /> MAIL ADDRESS <br /> qp�NITEGT OR OESIGNER <br /> MAIL ADORESS GITY <br /> ZIP PHONE LIGENSE I <br /> GENEPALGONTFAGTOR <br /> Z�p PHONE LICENSE� <br /> MAIL AD�RE55 CITY <br /> MECHANICALGOHTRAGTOR <br /> lApIL ADORESS <br /> CITY ZIP PHONE UCENS � <br /> PLUM��NGfANTPACTOR � <br /> Same <br /> C1A550F WOPK � <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN GARAGF <br /> VALUATION OF YJORH <br /> OESCRIBE WORK <br /> PROPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> LEGAL DESGRIPiION OF PROPERiY ISNOW�ELOW OR AiTACH FOUR CAPIE51 ALL PROVISIONS OF LA�NS AND ORDINANCES GOVERNING THIS <br /> TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> �or d�aK—°F HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO� <br /> VISIONS OF ANY OTHER STATE OA LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTR�iC��81 <br /> SIGNATUAE OF f,ONTq CTOP_O^R AUTMORI�E AGENT � <br /> JOBA�DRE55 X "" ' ' <br /> 1609 Lombard <br /> M C NICAL — <br /> PLUMBING TYPE OF EOUIPMENT FEE <br /> FEE N0. <br /> NO. TYPE OF FIXTURE OR ITEM piq cONo.uNrts—H.e EA. <br /> WATER CLOSEi ITOILET) qEFf�IGERAT10N UNITS—N�.R EA <br /> BATHTUB BOILERS—H.P.EA. <br /> 1 �yATORY(WASN BASIM GAS FIRED AQ UNITS—TONNAGE EA <br /> SHOWER FORCED AIR SYSTEMS—�TL. M EA. — <br /> � KITCHEN SINK 8 DISP. WALL HEATERS—BT��� M <br /> DISHWASHER UNITHEATERS—BT.U. M � <br /> LAUNDRY 1RAY EVAPORATIVE COOLERS <br /> CLOTHES WASHER CLOTHES DRYERS <br /> ]. WATER HEA7ER VENTILATION FAN <br /> URINAL RANGE HOOD <br /> DRINKING FOUNTAIN pIR HANDLING UNIT— C.F.M. <br /> FLOOR DRAIN STOVE <br /> VACUUM�PEAKERS METAL FIREPLACE&CHIMNEY <br /> ROOF DRAINS—RAINLEADERS <br /> SINK ISERVICE—BAR.ETC.) <br /> SUBTOTAL E <br /> SUB TOTAL PEHMIT s <br /> PERMIT 5 TOTAL FEE S <br /> — TOTAL FEE S PLAN CHECK FEE <br /> REAR YAFD SETBACK PLAN CHECK NUMBER pECEIPT NO. <br /> SIDE YARD SETBACK STREET SETBACK FEE <br /> VACANT SITE VALUATION FEE <br /> LOT AREA FEES <br /> USE ZONE l]YES L-.NO <br /> TY'PE OF CONST. OCCUPANCY GFOUP N0.OF DWELLING UNI75 � <br /> BUILDING <br /> N0.OF STORIES MA%.OCC. LOAD 13 �� <br /> SIZE OF BLDG. PLUMBING <br /> BASEMENT FIRE SPRINKLERS p�ECHANICAL <br /> FIRE ZONE REOUIRED <br /> CIYES i iN0 <br /> OATE OTHER <br /> pPPROVALS BY <br /> U.B.0 <br /> PENnLTV SEC.3031a) <br /> 1. ENVIRONMENTALCHECKLIST 13 00 <br /> 2. BU�LDING PIANS TOTAL <br /> 3. FIRE HVDRANT pERMIT VALIDATION <br /> d. FIRE PROTECTION S�STEM WHEN PROPERLY VAUDA7ED(w THIS SPACEI THI515 YOUR PERMIT � <br /> �� � � � !, � ^; � 3 rn — a�, <br /> 5. GRNDING - ' � <br /> —�_ <br /> 6. DRAINAGE � <br /> ' LI:':I!iONMLI:T:,1 IC.,nC . . '._ _ . _ — �� <br />