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- , <br /> dieE��ergreen " C�NSTRUCTION � � � <br /> CITY OF <br /> everett PERMIT pERMIT NO. 0�600 <br /> CITV HALL 259�B7d5 <br /> EVERETT.WA 98201 ❑ COMBINATION � BUILDING ❑ MECHANICAL P�UMBING <br /> OWNER MAIL�OpRE55 CITY ZIP PHONE <br /> Roger Gail Evans 2516 Lombard Ave. 98201 259-2769 <br /> ARCHREG70R�ESIGNER M/.iL�D�RESS CI7Y ZIP PMONE <br /> GENERAL CONTPAGiOR MFIL ADDRE55 , CITY ZIP PHONE LICENSE! <br /> NS{ABX Sanie <br /> MECHANICFL CONiRACTOR MAIL AOORESS CITY 2ip PHONE LICENSE 1 <br /> PLUMBIHGCONTRACTOR MFILAODRESS CIiY ZIP PMONE LICENSEI <br /> ClASSOF WORK <br /> ❑NEW ❑ADDITION H�ALiERATION ❑REPAIR ❑DEMOLITION ❑PENCE ❑SIGN ❑GARAGE <br /> VALUFTION OF WORK <br /> y 1,000.00 <br /> DESCflIBE WORK <br /> repair founciation <br /> PflOPOStD USE OF�WLDING <br /> single family garag;+ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �ecn�_oescaivnoNOFPaoPearvisNowee�owoannnc��Fouacoaies� PLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �oi 15 BiocK 56�,F Everett TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PE9MIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO� <br /> � VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE GONiRACTOR OR P iMOfiIZED AGENT DATE <br /> JOB nDDRESS — cJ/l�j/80 <br /> 2516 Lombard Ave. X ��,��/�_ <br /> PLUMBING MECHANICA <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIR COND.UNITS—FI.R EA. <br /> BATHTUB REFRI6ERATION UNITS—H.P. EA <br /> LAVATORY(WASH BASIN) BOILERS—H.P.EA, <br /> SHOWEfl GAS FlRED F.C.UNITS—TONNPGE EA. <br /> KIICHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.LU. M EA. <br /> �� DISHWA: ER WALL HEATERS—B.T.U_ M <br /> LAUNDRY TRAY UNIT HEATERS—B.T.U. M <br /> f` CLOTHES WASHER EVAPORATIVE COOLERS <br /> 4V'ATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> �'� DRINKING FOUNTAIN RANGE HO00 <br /> � FLOOR DRAIPI AIR HAPIDLING UNIT— QF.h1. <br /> VACUUM BREP.KERS STOVE <br /> ��' ROOF DHAIPlS—RAINLEADERS ' METAL FIREPLACE 8 CHIMNEY <br /> SINK ISERVICE—BAR,ETC.) — <br /> SUBTOTAL SUB70TAL S <br /> PERMIT S PERMIT t <br /> TOTALFEE S TOTALFEE _ <br /> SIDE YAflD SETBACK STREE7 SETBACK FEAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> PEE RECEIPT NO. <br /> USE ZONE LOT AREA ❑YES Tf_1N0 FEES VALUATION FEE <br /> � TYPE OF CONST, OCCUPANCY GROUP NO.OF DWELLING UNITS '� <br /> BUILDING $1000.00 LO 00 <br /> SIZE OF BLDG. NU.OF S70RIE5 MA%.OCC. LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT pEpUIRRIpNKLERS MEGHANICAL <br /> C'/'t5 ❑NO <br /> APPHOVALS BY DATE OTHER <br /> � <br /> 1. ENVIRONMENTAL CHECK LIST PENALTY U.B.C. <br /> SEC.3031a) <br /> 2 BUILDING PLANS � <br /> TOTAL ZO 00 <br /> 3. FIRE HYDRANT <br /> 4. FIRE PROiECTION SYSTEM FF.NMIT VALIDATION ' <br /> WHEN PROPERLY VALIDATED(IN 7HI5 SPACEI7HIS IS VOUR PERMI7 <br /> 5. GRADING <br /> 6. DRAINAGE 12 9 6 S Q I O. O 0 —' � <br /> 7. ENVIRONMENTALIMPACTSTFTEMENT � � <br /> __ ti <br /> 8. HEALTH DISTRICT � <br /> APPLICATION ACC.BY PLANS CHECKED BY APPfl.FOR ISSUANCE BY Y�7 U R R E C E I PT � <br /> THP,f�K Yt�U <br />