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die Ll�rr¢reeii <br />o�; c: <br />everett <br />CIT1' MALL 259�Bi45 <br />EVERETT, WA 48207 <br />� � � CONSTRUCTIO"o <br />PERMIT <br />❑ COMBINATION � BUILDING ❑ MECHANICAL <br />PERMiT NO. �4ZHi <br />❑ PLUMBING <br />OWNEH MAILADDPE55 CITY ZIP PMONE <br />HARVEY A. ROSSITER PO BOX 2201 EVERETT 47A 88203 353-1479 <br />APLMITECT OR OESIGNER MAR NOORE55 CITY LP PHONE <br />GENERAL CONTflAGTOH MAIL ADDRESS CITV ZIP PMONE iICENSE � <br />$IihiFi <br />MELMANICAL GONTRRCTOR MAIL AD�FESS CITY 21P PMONE LICENSE � <br />FWMBING GONTflAGTOR MAIL ADDRE55 CRY ZIP FMONE LIGENSE � <br />y��� Vr ••V^^�7JEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOU� STOVEIFIREPLACE INSERT <br />VRLUATION JF WORK <br />S L�UQOa <br />Carport <br />EGAL DESCFIPT:JN OF PROPERTY �SHOW BEL <br />LOT �_ BtOCN ��OF _�DTI�¢AL <br />OB ADDRESS <br />5921 LOMBARD <br />PLUMBING <br />N0. TYPE OF FIXTURE OR <br />WATER CLOSET �TOILEn <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASMER <br />WATER F�EATER <br />URINAL _ <br />DRINKING FOUNTAIN <br />FLC�OR DFAII� <br />VACUUM BREAKERS <br />ROOF ORAINS — RAINLEADE <br />SINK (SERVICE — BAR, ETC.) <br />4' <br />USE ZON <br />R-1 <br />7/PE OF <br />V-N <br />SIZF OF <br />�.ZXii <br />FiRe zor <br />SUB 70TAL s <br />PEPMIT s <br />TO7AL FEE S <br />REET SETEACK REAR <br />20' <br />T AREA VACAI <br />9000sf :'res <br />:CUPANCY GFOUP NO. O <br />M-1 <br />l. OF STORIES MA%. � <br />APPflOVALS Br <br />1. ENVIRONMENTAL CHECK LIST <br />2. 6UILDING PLA�: + <br />3. FIRE HYDflANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIFONMENTALIMPACTSTATEMENT <br />8. HEALTH DISiRICT <br />APPLICATION ACC. BY PLANS CHECKE� BY APPR. <br />eb � jef <br />lc <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL P!�OVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE Of WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HERElN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNAfTl�1R/E OF CONTRAGTOR OR AUTHORIZ,yE �GENT OATE <br />X i/�„ . _ ✓ . / �i /1 C-r✓--✓ -t.. <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMEN7 <br />AIR COND. UNITS — H.P. EA. <br />REFRIGEFATION UNITS –� H.P. EA. <br />BOILERS — M.P. EA. <br />GAS FIRED A.G. UN'�TS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOlERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOO� <br />AIR HANLLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIHEPLACE 8 CHIMNEY <br />FIFEPLACE INSERT <br />HEAT PUMP <br />84/14181 <br />FEES <br />BUILDING <br />PUIMBING <br />MECHA�IICAL <br />OTHER <br />PENALTV <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE f <br />PI.AN CHECK FEE <br />FEE ,�e48 ,�2604 EIPTNO. <br />VALUATION FEE <br />S <br />U.B.C. <br />SEQ 903 <br />TOTAL I I i7 � 50 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED pN THIS SPACFj THIS IS VO�R,PERMIT _ r-{'. <br />�. �� <br />$3.90 due on plan check fee � <br />�' <br />�� <br />0Y <br />ADDRE55 FIIE <br />,>�.;" <br />:�,. �� <br />y <br />n <br />bl <br />H H <br />H ^7 <br />H �� <br />� <br />L � <br />� <br />N <br />� Z <br />t" � <br />H F-1 <br />� � <br />O � <br />[*J H <br />� <br />� � <br />. � <br />� <br />x <br />H <br />N <br />y <br />H <br />n <br />b] <br />