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�he Ecer,treen �� O N Si R lJ CT I� � <br />Ciiv 0� �� <br />evereti PERMIT PE,��T ��. � 4 �J <br />CITY NALL 259�8745 <br />EVERETT,VlA9B201 ❑ COINBINATION � BUILDING ❑ MECHANICAL ❑ PLUh!BING <br />OWNEN MAILADDRESS CITY ZIP PMONE <br />Eld��n 2yals 124 Madison Everett <br />ARGHIiELi OR OESIGNEfl MAIL ADORE55 LITY ZIP PryONE <br />GENERAL CONTHpGTOR .•!41i. A�DqESS CITY ZIP PHONE LICENSE � <br />Tedjan Construction _ J_.;_�:;2 106th N.E. Kirkland 98C33 822-9079 <br />MECHANIGAL COIJTRAGTOP. MAiL A�DRESS CITY ZIP PHONE LILENSE N <br />TEDJACC164MC <br />PLUMBING CGNTRACTOR MAIL A�LnE55 QTY ZIP PMONE LIGENSE N <br />❑ NEW O ADDITION ❑ qLTERn710N O REPAIR I] DEMOLITION O FENCE ❑ SIGP: ❑ WOOD S70VEIFIREPLACE INSERT <br />' *XXXxy.X a,000.00 <br />DESCRIBE WORK <br />Single Family Residence <br />EGAL OESCRIPTICN OF PROPEflTY (SHOYJ BELOW Ofl <br />LOT_fiLOCN__OF Beverly ; <br />O� ADDRESS <br />124 Madison <br />PLUMBING <br />NO. TYPE OF FIXTUFE OF <br />WATERCLOSET�TOILEn <br />BATHTUB <br />LAVATORV�WASHBASIN) <br />S40WER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRY7RAY <br />CLGTNESVJASHER <br />W�TER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />SINY. (SERVICE - BAR, tTC.) <br />Tracts <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAti11NED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS Or LAW3 AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMFLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERM1tI"f DOES NOT PRESUME TO Gi\'.. AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OH <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCEOFCONSTRUCTION. <br />SIGNATU� OF QONTRAC7pR Oq AUTHORIZED AGENT DATF <br />X .��-GC/ ���/4y.lirYl/ <br />MECHANICAL <br />N0. TYPE OF E�UIPMENT <br />AIR COND. UNITS -� H.P. EA. <br />REFRIGERATIC�;� UNITS - H.P. EA. <br />BOILERS -- H.P. EA. <br />GAS FIRED A.C. UNITS - TONNAGE EA. <br />FORCED AIR SVSTEMS - B.T.U. M EA. <br />WALL HEATERS - B.T.U. M <br />UNIT HEPTE(i5 - B.T.U. M <br />EVAPORC.TIVE COOLEFS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HAN�LING UNIT - C.F.M. <br />ST'JVE - 1h'OOJ <br />METAL FIREFI.P.CE & CHIMNEY <br />FIREF'LPCEINSERT <br />H'AT PUMP <br />SUB TOTAL S <br />PERMIT S <br />TO7AL FEE 5 <br />ARD SgE�TBAG 5� STREEI' SETzAaCK REAR VARD SETBACK PLAN <br />2C <br />)NE LOT AREA VACANT SITE <br />R—Z ;.vEs xwo <br />V—N <br />SIZE OF BLDG. <br />672 Sq. Ft. <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUIL�ING PLANS <br />3. FIRE HYDRANT <br />4. FIqE PROTECTION SYS7EM <br />5. GRADING <br />6. DRAINAGE <br />M <br />1 <br />7.ENVIRONMEN7ALIMPACTSTATEME'JT <br />SU9 70TAL <br />PEFMIT <br />TOTAL F'EE <br />85/14975 IFEE 44.53 <br />N/A _ eui�owc <br />!AX. OCC. l.OAD - <br />N�A PLUA161NG <br />IPE SPRINKLERS MECHANICAL <br />EOUIRED <br />:YES : O <br />BY DATE OTHEFi <br />PENALTY <br />8. HEALTH OISTRICT � <br />APFI.ICATION ACC. BY PLANS CHECKED BY APPP. FOR ISSUANCE BY <br />EB HWM � LC <br />VALUATION <br />$8,000. <br />U.B.C. <br />SEC.303 <br />^2/.. <br />� <br />S <br />E <br />CHECK FEE <br />RECEIPT NO. <br />6951- <br />FEE <br />68 50 <br />TOTAL I � ($ rjQ <br />PEfiMIT VALIOATION <br />WH[N PROPERLY VALIDATED (IN 7HIS SPACE) TFIIS IS.YCUA PERMI7 �(] <br />� . . � -. {•. . � � <br />� <br />�' <br />' � <br />ADD::ESS Fll.t <br />