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1 <br /> die E��ergreen � ��I ST R U CT I�N � � <br /> ci'v cr <br /> everett PER�VIIT PERM�T ��o. , � <br /> CIiY HALL 259-&r4: <br /> rveHerr.v.�n eazoi ❑ COMBINATION � BUILDING ❑ MECHANICAL LI PLUMBING <br /> �.. _.,, ��ni�nuo��es, c�t� nN F��cr.e — <br /> Oswald L. Forstad 2025 i,ombard 98201 252-4984 <br /> . ,��i Cq pESiGNLR �qqlLl.UDFC55 Ciiv �IF FnONE <br /> ��i�.'.`�,:1C01:ienCiOR MAiLACD�t55 GITY ZI� PHOI�[ Li[:i4 <br /> Brown's Remodel and Repair 4420 Grand Ave. 98203 258-1331 <br /> .._.'i.,nryICALG011iRAGtOP MAILADD9'.`.5 GIiY ZIP PHOIJE LICi'.L'� <br /> BR OW NR R263NS•7 <br /> i-w!nrr.�e ccr�rvvncroa rana nooaess cilv zi❑ r��oru� ua�.-��.� <br /> cr,.cs oF wonK — <br /> ❑NEW ❑ADDITION ❑ALTERATION �REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> .:.'�i;:d10N OP VJORK <br /> s 10,216.00 <br /> rn s�.wioe woe� <br /> interior and exterior repair <br /> vnoro.=,ro use oF owiou��, — <br /> single family residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS F+P- <br /> �ecai.oEscnir�nouocrrorer+rris+o:+oeioweenitna�Fou�cowcsi PLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. <br /> 13-14 420 Everett Div. K ALL PROVISIONS OF LAWS AND ORDI�IANCES GOVERNING THIS <br /> �or o�a.:K_oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> 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 OR LOCAL LAbV REGULATING <br /> � CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> JOPADDRE55 SIGNAiUi". OFC�ACiOPORl.11iHpRIZCUAGE1lt DNE <br /> 2025 Lombard X /. � � ,�� 10/12/79 <br /> PLUMBING CHANICAL <br /> NO. TYPE UF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> I. WATER C:OSEi(TOILET) 2 QQ AIR C.OND. UNITS— H.P.[A. <br /> 1 BATFTUB REFRIGEaATION UNITS—H.P. EA <br /> 1 LAVFTORY�N/ASH BASIN) z QQ �OILEflS—H P.EA. <br /> SH0IVER GAS FIRED A.C.UNITS—TONNAGE FA. <br /> KITCHEN SINK&DISP. FORCED FIR SYST[MS— �S.LL h1 EA. <br /> DISHWASHER 1VALL HEATERS—B.LU. 1d <br /> � LAUNORY TRAY UiJIT HEATERS—B.T U A9 <br /> CLOTHES WASHER EVAPOHATNE COOLERS <br /> � WATER HEATER GLOTH[5 DRYERS <br /> � URIN4L VENT�LATION PAN <br /> � DRINKING FOUNTAIN FANIiE HODU <br /> FLOOR DRAIN �IR HANDLING UNIT— C F W. <br /> VACUUAI�R'cAK[RS STOVE <br /> ROOF DRAINS —RAINLEADERS ME7AL FIREPLACE&CHIMNEY <br /> SINK�SERVICE—BAR,ETC.1 <br /> SUBTOTAL 6 00 SUB TOTAL 5 <br /> PERMIT 5 PERMIT S <br /> TOTAL FEE S 6 TOTALFEE 5 <br /> SIDP Y�RD SETBAGK SiREET SLiE3PCK REAR YAFD SEfBACK PLAN CHECK NUMPER PLAN CHECK FEE <br /> FEE RECEIPT �iJ <br /> liSE 7GNE LOT 4REA VACANT SRE __-- <br /> L1VC5 ❑NO FEES VALUATION FEE <br /> �_— <br /> I sP'd OF CONST. UCC'1PANCY GROUP NG.OF DWELLING UNITS <br /> eui�oiNc s10,216.00 56 00 <br /> .'��..'i. OF BLDG. NO.OF STORIES MAX OCC.LOAD <br /> PLUMBING n �� <br /> �, �� .'ONE BASEMENT PIRE SPRINKLEHS <br /> RGOUIFED MECNANICAL <br /> ! !yE5 i-1N0 <br /> � APPAOVALS BY DATE <br /> OTHER <br /> � CtJVIRONMFNTAL CHECK LIST PENALTY U.B.C. <br /> 2 BUILDING FLl�NS Ga� SEC.303(a� <br /> '; FIREHYDRANT ,r TOTAL (z Op <br /> e cior-pit[i7crrin�c.e�! PEPMIT VALIDA710N <br /> IVHEN PROPERLY VALIDATEU pN THIS SPACE)THIS IS YOU P 1 <br /> '° �fA : 3 5 l 8 .� i�!���.D O --_.����' <br /> fi. 14PAI GE � " • <br /> _ - . CV <br /> '.�VIBONMENTA�APACT STATEMENT • " <br /> �j {- (�y�i <br /> t..NEAII'�,DISTRI� i��11in ��CL:It {_jl <br /> { <br /> _-� <br /> � ;.�P�I ON ACC PU1NS CHECKED BY APPR.FOR ISSUANCE BY '_�) U �-- <br /> ._: � � .,�., , •: . . <br /> :_ b � <br /> i�_ <br /> � � . : <br /> �,: � .. <br />