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, <br /> �` CrNSTRUCTION � . <br /> Nte Evergreen � .�-, <br /> CITY OF <br /> evere� PERMIT PERMIT NO. OH6OO <br /> CITY fIALI 259�8745 <br /> EVEHETf,WA 98201 ❑ COM8INATION ❑ BUILDING IX�CMECHANICAL PLUMBING <br /> OWNER MPILADDRE55 CIiY ZIP PHONE <br /> Bethany Homes 3305 Lombard I <br /> ARCNRECT OP OESIGNEB MAIL ADOflE55 CITY ZIP PHONE <br /> GENERALWNiRAC10R MAILAD�RE55 GITY ZIP PHONE UCENSF.I ' <br /> � <br /> MECHAIllCAL CONTMCTOR MPIL ApDRE55 CITY ZIP PHONE LIGENSE Y <br /> Natural Gas Equipment 1611 East Grand 258-2441 <br /> I <br /> PLUMBINGCONTRAGTOR MAILAOORESS CITY ZIP PHONE LIGENSEI <br /> ClASS OF WORK <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑OEMOLITION ❑FEIJCE ❑SIGN GARAGE <br /> VALV/TION OF WORK ' <br /> $ 1 <br /> �ESCRIBE wORK <br /> PROPOSED USE OF Bl11LDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �E�.�ioescaiPnoNOFaeoaea*riseowee�owoanrrncNFouacoaies� PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �or e�ocK—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 LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATU E OF GONTRACTOR OR AUTNORIZED AGENT DATE <br /> JOB A[1DFE55 11/2 0/8 0 <br /> 3305 Lombard X (,L <br /> PLUMBING MECHANICA <br /> NO. TYPE OF FIXTURE OR ITEM FEE NU. TYPE OF E�UIPMENT FEE <br /> WATEIi CLOSEf(TOILET) AIH COND.UNITS—H.P.cA. __ <br /> BATHTUB REfflIGERATION UNI75—HP.EA <br /> LAVATORV�WASH BASIN) BOILERS—H.R EA. <br /> SNOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORCED PIR SYST6M5—B T.U. M EA. <br /> DISHWASHER V✓ALL HEATEA�—B T.U. M <br /> LAUNDRY TRAY UNIT HEATEFS—BS.U. M <br /> CLOTMES WASHER EVAPOFlATIVE COOLERS <br /> ' WATER HEATER CLOTHES DRVERS <br /> VENiILATION FAN <br /> URINAL <br /> DRINKING FOUNTAIN RANG�HOOD <br /> FLOOR DRAIN AIR HANDLING U�JIT— GF.M. <br /> VACUUM BREAKERS SiOVE _ <br /> ROOF DflAINS—RAWLEADERS IdETAL�IftEFLACE&CHIMNEY _ <br /> SINK(SERVICE—BAR,ETC.) 1 Water Heater <br /> I. <br /> SUB TOTAL SUB TOTAL S 2 O O <br /> PEflM1T S PEHMIT S <br /> � TOTALFLE S TOTAL FEE S S O <br /> SIDE'iAflD SETBACK STflFE'. oETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NG. <br /> USE ZONE '.OT ARFA VACAN'SITE <br /> ❑YES ❑NO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING 11NITS <br /> BUILDING 5 <br /> SIZE OF BLDG. Np.OF STORIES MAX.OCC.LOAD <br /> PLUMBING <br /> FIFE ZOFE BASEMENT qEpUIRED KLERS �,�ECHANICAI S 0 0 <br /> ❑YES ❑NO <br /> APPHOVALS BY DATE OTHFR <br /> 1. ENVIRONMENTAL CHECK LIS7 PENALTY U.B.C. I <br /> SEC.303(a) <br /> 2. BUILDINGPLANS S OO '' <br /> TOTAL <br /> 3. FIRE HYDRANT <br /> 4. FIRE PROTECTION SYSTEM PEHMIT VALIDATION <br /> 5. GRADING WHEN PROPERLY VALIDATED(�N THIS SPOACE�i H,,IS IS YQ�UF�P�R�ITO ^ O ^ <br /> y lJ �J �-� <br /> 6. DRAINAGE � <br /> 7. ENVIRONIdENTAL IMPACT STATEM1IENT � CD <br /> ; (; �;;-�::i:IPc3o <br /> 8. HEALTH DISTRICT O <br /> i ,t <br /> APPLICATION ACC.BY PLANS CHECKED BY APPP.POR ISSUANCE 8Y � . '�.��•� � {� u <br /> 1 <br /> n � <br /> / I Id.�� G� <br /> ADDRESS FILE __ <br /> �i <br />