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The Evergreen _ CITY OF CI N ST R U CT I O N <br />evereft PERMIT PERMIT NO.09747 <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 ❑ COMBINATION ;U BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />16 Olive Kelley 5904 Lombard Everett 98203 353-7417 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />Owner <br />MECHANICALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP NONE LICENSE <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION XR]REPAIR ❑DEMOLITION OFFENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />: 600. <br />Composition reroof <br />PROPOSED USE OF BUILDING <br />Residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TC 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 />SIGMA O CONTRACTOR R AUTI RIZED A NT DATE <br />X <br />LEGAL DESCRIPTION OFPROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />16 11 Laurel Heights <br />Lot RLac�oP 9 <br />JOB ADDRESS <br />5904 Lombard <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATIC4 UNITS — H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />KITCHEN SINK S DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA, <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C_F.M. <br />VACUUM BREAKERS <br />STOVE _ <br />_ <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT f <br />TOTAL FEE <br />S <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />LIVES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S 600.00 <br />11 <br />50 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE <br />REQUIRED <br />❑YES <br />SPRINKLERS <br />❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.. 3C. <br />SEC03 (a) <br />2. BUILDING PLANS <br />TOTAL <br />11 <br />150_ <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />r <br />_ Cr <br />- If IC <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />°1 <br />0 <br />ADDRESS FILE 7 0 <br />