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Me EvergreenCITYJF C ®N S i RUC E I V "■ <br />everett PERMIT PERMIT NO. 12828 <br />CITY HALL 259-8745 _ <br />EVERE7T. WA 98201 RR COMBINATION 93 BUILDING MECHANICAL x! PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Duane Hasko 15810 Springtis:e Lane Bothell 98011 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 21P PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />D. G. Brandvold <br />5307 139 Avenue S.E. <br />Snohomish <br />098290 568-9342 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE I <br />DG BA AC171CM <br />PLUMBING CONTRACTOR <br />MAIL ADDRE55 <br />CITY <br />21P PHONE LICENSE 8 <br />CLASS OF WORN <br />R}WEW ❑ADDITION [I ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />VALUATION OF WORK <br />S 37,000.00 <br />DESCRIBE WORK <br />Construct single Family Residence <br />Family Residence <br />LOT 2 BLOCK _OF <br />Acreage Tracts <br />A 12 28 4 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER 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 REGULATING CONSTRUCTION OR THE <br />cFEFC)RMANCE OF CONSTRUCTION. <br />JOB ADDRESS <br />SANAALVEOF CONTRACTOR UTHORIZ AGENT <br />URIC <br />/ <br />7029 Lower Ridge Road <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />1 <br />WATER CLOSET (TOILET) <br />2 <br />00 <br />AIR COND. UNITS — H.P. EA. <br />]. <br />BATHTUB <br />2 <br />REFRIGERATION UNITS — H.P. EA. <br />1 <br />LAVATORY (WASH BASIN) <br />2 <br />00 <br />BOILERS — H.P. EA. <br />SHOWER <br />I <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />1 <br />KITCHEN SINK & DISP. <br />2 100 <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />1 <br />DISHWASHER <br />2 100 <br />WALL HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />11 <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />2 <br />00 <br />1 <br />CLOTHES DRYERS <br />4Y_ <br />URINAL <br />], <br />VENTILATION FAN <br />6_ <br />DRINKING FOUNTAIN <br />1 <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />], <br />STOVE - WOOD <br />7 <br />S <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL <br />+' <br />14 <br />0 <br />SUB TOTAL <br />S <br />19 <br />50 <br />PERMIT <br />S <br />PERMIT <br />S <br />TOTAL FEE <br />S <br />14 <br />00 <br />TOTAL FEE <br />$ <br />19 <br />50 <br />SIDE YARD SETBACK <br />ET <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEi.16.68 <br />CHECK FEE <br />No. <br />FX <br />pz�r <br />83/12828 <br />66W26IPT <br />USE ZO <br />LOT AREA <br />VACANLSITE <br />FEES <br />VALUATION <br />FEE <br />z- <br />E�<S LINO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />N0. OF DWELLING UNITS <br />BUILDING <br />S 37,000.00 <br />224 <br />50 <br />V-N <br />R-3, M <br />1 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />t-3 984 S. Ft. <br />1 <br />4 <br />PLUMBING <br />14 <br />00 <br />:a <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />IRED <br />MECHANICAL <br />1 <br />50 <br />OTHER <br />OYES ENO <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />258 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEW <br />PERMIT VALIDATION <br />WHEN PROPERVALIDATED (IN THIy PI THIN <br />PIR/111T <br />5. GRADING <br />jLY l�S.IYT4 <br />j <br />'� 3 <br />Y t-) <br />(( (( 1ljj ��JJ cc <br />n <br />U R RECEIPT *- <br />YOU <br />.DRAINAGE- =.- 6� <br />- <br />7.ENVIRONMENT4LIMPAC`litATEMENT <br />SHEALTH I TFj.IOT <br />&PLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />EB := �' <br />o HwN <br />Lc <br />i R RECEIPT <br />� I-, <br />pJt, YOU <br />LTl <br />H 1- <br />H U. <br />'G r <br />O <br />F: <br />CUrF'. <br />- I FEB 8 4 <br />ADDRESj FILEc <br />