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theEvergreen ,, C�VSTRU TTION •• <br />QTY OF <br />everett P�R� PERMIT NO.O79S5 <br />CITY HALL 259�0745 <br />EVERETf, WA sezoi ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAILADDRE55 CITY ZIP PHONE <br />Clayton Bernard <br />ARCHrtEGT OR DESIGNER MRII ADDRE55 QTY ZIP PNONE <br />GENERALCJNTRACTOH �1AILADDRE55 GTY 21P PHOYE LICENSEI <br />Star Home improvement 5314 2nd Street Everett 98203 353-9278 <br />MECHANIC/I.CONTRACiCF MFILAOORE55 LITV ZIP PHONE LICENSE� <br />DI ED RWK312DC <br />~ V�UM9WGCONiPACfOR MAtLApDRE55 Gitt 71P PHONE IICENSEI <br />CL1550F WOPK <br />❑NEW ❑ADJITION ❑ALTERATION �REPAIR ❑OE�AOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VAWATION OF WOfIN <br />s 4,500.00 <br />DESGAiBE WORK <br />PROPOSEU USE OF BUiL01NG <br />l[GAL DEYRIVTION OF FROPERTY �SMOW BELOY/ OH ARACH FOUR WPIES� <br />��r 14 ei�� 9 oF Laurell Heights <br />JU9 AOORL55 <br />5617 Lowell Road <br />PLUMBING <br />NO. � TYPE OF FIXTURE OR ITEM FEE <br />TRAY <br />URINAL <br />VACUUId BREAKERS <br />ROOF DRAINS — RAIN <br />SINK �SFRVICF — RAR <br />SIDE VARD SETBACK I STFEET SEIBACK <br />USEZONE LOT <br />TYPE OF CONST. JCC <br />V-N <br />SIZE OF BLDG. NO. <br />FIRE ZONE BAS <br />3 <br />APPPOVAI <br />1. ENVIRONMENTAL CHECK IIST <br />2. BUIIDING PLANS <br />3. FIRE HYDRANT <br />4. FIfiE PROTECTION SYSTEM <br />5. GRADING <br />I HEREBY CERi�IFY THAT I HAVE READ ANL� EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TIiUE AND CORRECT. <br />ALL PROViSIONS OF LAWS AND ORDINANCE:� GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WNETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PE�,9MI' DOE5 NOT <br />PRESUME TO GNE AUTHORITY TO VIOLATE OR G4NCELTHE PRO- <br />VISIONS OF ANY OTHER STATE OH LOCAL IAOV NEGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNnTURE OF COrviRFCTOR GR AUTMOaI�Ep A�G�ENT �ATE <br />X 7-L_=/���'_'.=7r �Q . .!l... �. �/22/80 <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />REAR YARD SETBACK IPLAN <br />❑YES Cj{� <br />�CY GROUP NO. OF OWEL <br />R-3 1 <br />TORIES MA%. OCC. LC <br />L <br />6. DRAINAGE <br />7. ENVIRONMENTALIMPACT STATEMENT <br />8. HEAITH DISTPICT <br />APPUCATION ACC BY PLANS CHECKED BY <br />v.c. <br />APPF. FOR 153UANCE EV <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNIiS — H.P. [F <br />ROLLERS — H.P. EA. <br />t;na rmeu r�.� �rvi ia — i�rvrvH¢ <br />FOFCED AIR SYSTE1d5 — B.T.U. <br />WALL HEATERS — B.T.U. <br />i i.ur uGercoc _ a r i i <br />FAN <br />AIR HFNDLING UNIT — <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />P'cNALTV <br />TOTAL <br />TOTALFEE <br />FEE <br />�4 <br />M <br />M <br />Cf <br />U.9.0 <br />SEC. 303 (a) <br />RECEIPT NO. <br />IN FEE <br />00 32 00 <br />321 00 <br />:�HEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS VOUR PERMIT <br />5143 ��32.0� -=s � <br />� <br />YOUR RECElPT o <br />T'-; A fJ K Y'p U <br />ADDRESS <br />� 2 Jlfl 8 � <br />