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Me EecrgreeN <br />CITY 01- <br />everett <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 <br />CONSTRUCTION <br />PERMIT <br />❑ COMBINATION aBUILDING 11 MECHANICAL <br />E <br />PERMIT NO. 06550 <br />❑ PLUMBING <br />OWNER MALL ADDRESS ZIP PHONE <br />Mrs. Boone 1905 Madison 98203 353-1802 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Riverside Roof Company 2916 State Street 258-4646 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />RI VE RR *302TO <br />PLUMBING CONTRACTOR MAIL ADDRESS CRY ZIP P. ONE LICENSE, <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION X}REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />s 1,354.00 <br />Repair re -roof with composition <br />PROPOSED USE OF BUILDING <br />single family 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 TO 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X Check #2634 8/16/79 <br />LEGAL DESCRIPTION of PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES - <br />16-17 4 Pinehurst <br />LOT SLOCK_OF <br />JOB ADDRESS <br />1905 Madison <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 />REFRIGERATION UNITS — H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA, <br />SHOWER <br />I <br />GAS FIRED A.C. UNITS — TONNAGE 2A. <br />_ <br />KITCHEN SINK & 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 />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />I CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE H.AOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE &CHIMNEY _ <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />_ SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET .SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK N.JMEIER <br />PLAN CI IECK <br />FLE <br />FEE <br />RECEIPT NO. <br />USE ZONC <br />LOT AREA <br />VACANT SITE <br />❑YES LIND <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ 1354.00 <br />14 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL. <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U B . <br />SEC. C303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />19 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />GRADING <br />PERMIT VALIDATION WHEN PROPERLY VALIDATED (IN THIS SPAJEjT. ljiS Y0j TFr4. Q Q CD5. <br />``JJ 66 BUJ II �9L <br />- <br />'Yob R nc.Flu <br />,THANK YOU' <br />�A <br />0. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADD ,�ESS FILE <br />