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1 <br /> dic£eerxreen �O N ST R U CT I O F' <br /> cirv 0� ' <br /> �V�14.1.l. PEf3MIT PERMIT N0. 1�4 � 1 <br /> CITY HALL 259�B7d5 <br /> EVEflETT.VJA98201 � COMBINATION ❑ BUILDING .�gJ MECHANICAL ❑ PLUMBING <br /> p1YNER <br /> MAIL A�ORE55 GTY ZIP PNONE <br /> Charles Neff 3128 Lombard Eve�ett 98201 259-3648 '� <br /> FRCNITECT OR OESIGNER H41L AOOPE55 CITY Z�P PMONE <br /> r <br /> GENEFAL CONTPAGTOR <br /> IdnIL ApDRE55 GRY ZIP PHONE LIGENSE• <br /> MECHANI.NLCONTRFGTOR <br /> � MAIL ADORE55 CITY ZIP PMONE LICENSE M <br /> Same <br /> PLUMBV�G WNTPFGTOR <br /> MAIL ADORESS LITV ZIP PMONE LIGENSE x <br /> - � <br /> CLA55 OF YlOFN <br /> ❑ NEW ❑ NDOITION ❑ ALTERATION ❑REPAIR ❑ OEMOLITION ❑ FENCE ❑ 51GN �}(WOOD STOVEIFIREPLACE INSERT <br /> VALUATION OF WORK <br /> 5 <br /> OESGHIBE WGiiN <br /> aaovoseo use oF auaowc � I HEREBY CERTIFY THAT I HAVE READ AND EXAMW ED THIS <br /> APP�ICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAL OESCFIPTION OF PROPERTY�SHOW BE�OW OF ARACH FOIIR GOPIES� CORR=CT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> �or_a�ocK—oF WHE'i i1ER 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 PEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. oATE <br /> JOB ADORSSS SIGNATURE OF NTSA TOR F RI GENT <br /> 312L1 Lombard X ` � 9 12/83 <br /> PLUMBING <br /> MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE JF E�UIPMENT <br /> FEE <br /> WATERCLOSET�TOILE7) P.�R COND. UNI75 — H.P. EA. _ <br /> BATHTUB REFRIGERATION UNITS— H.P. EA. <br /> LAVP.TORYIWASH BNSIN) BOILERS — H.P. EA. <br /> SHOWER GAS FIRLD A.C.UNITS —TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS— B.T.U. M EA. <br /> DISHWASHER <br /> WALL MEATERS— B.T.U. M <br /> LAUNORVTRAY UNIT HEATERS— B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLEFS _ <br /> WATER HEATER CLOTHES DRYERS <br /> VENTILATION FAN <br /> UHINAL <br /> DRINKING FOUNTFIN RANGE NOOD <br /> FIOOR DRAIN AIR HANDLING UNIT — C.F.M. <br /> VACUUM BREAKERS 1 STOVE — WOO� <br /> ROOF DRAINS— RAINLEADERS METAL FIREPLACE 8 CHIMNEY _ <br /> SINK�SERVICE— BAR, ETC.) FIREPLACEINSERT <br /> HEAi PUMP <br /> SUB TOTAL S SUB TO7AL 5 7 O <br /> PERMI7 5 PERMIT 5 <br /> TOTAL FEE S TOTALFEE 5 <br /> pLAN CHEGK FEE <br /> SIDE YARD SETBACK STREET SETEACK REAR VAFD SETBACK PLAN CHECK NUAIBER FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> YES . NO <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNIiS — <br /> BUILDING $ <br /> 52E OF BLDG. NO.OF S70RIE5 MA%.OCC. LOAD pLUMBING <br /> FIREZONE BASEMENT qEpUSRED KLEFS �,�ECHANICAL ].� S O � <br /> YES NO <br /> � BY DATE OTHER _ <br /> APPROVALS U.B.C. <br /> 1. ENVIRONMENTAL CHECK LIST PENALTY SEC.303�a) _ _ <br /> 2.BUILDINGPLANS TOTA� ].� SO <br /> 3.FIRE HYDRANT A <br /> 4.FIRE PROTECTION SYSTEM yrH NITPROPIERLY�ALIDATED QN THI�§P$CLE)THIS�1�'�U�,P�f�1�T� .Iq <br /> 5.GRADING � <br /> 6.DfiAINAGE <br /> 7.ENVIRONMENTALItdPACTSTATEMENT '��� � R RECEIPT � . <br /> B.NEALTH DISTRIC7 "�+-���K YO U <br /> APPLICATION ACC. BY PLRNS CHECKED BY APPR.FOR ISSUANCE BY <br /> I 2 �E� 8 3 <br /> ADDRESS FIL't <br />