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r <br />theEvergreen CINSTRIICTION � � <br />pTY OF <br />everett PERN�IT pERMIT NO.OH6S6 <br />CITY HALL 259�6745 <br />EVEf7E17, WA 98201 ❑ COMBINATION � BUILDING ❑ MECHl+.NICAL ❑ pLUMBING <br />OIYNER MAIL AD�RE55 CIiY ZIP PNONE <br />F1oy�Tremmel 119 115th Street S.E. Everett 98204 353-9456 <br />ARGHITECT Oq DESIGNER GAIIADORE55 CITY ZIP PMONE <br />GENERALCONTRACTOR MAiLADDRE55 CITY ZIP pHONE LICENSEI <br />Same <br />MECHAHICAI WNTflACT9R NAILAODRE55 CITY ZIP PNONE �ICENSE I <br />PlUM81N6CANTRACTOR MAILAD�PESS QiY ZIP PH�NE LICENSE/ <br />❑NEW ❑ADOITION ❑ALTERATION ❑REPAIR �UEMOUTION ❑FENCE ❑SIGN ❑GARAGE <br />S <br />demolish single iamily residence and storaie shed <br />PROPJSEO USE OF BUILOING <br />single family residence <br />LEGAL �ESCFIPiION OF PqOP[RTV �SHCW �ELOW OR ATTACH FOUF COPIES', <br />1-2-3 16 Pinehurst Div. B <br />i0i BLOCIL_OF <br />iJ8 q00flE55 <br />2428 Madison <br />PLUMBING <br />NC. TYPE 01 <br />OR <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDflY TRAY <br />CLOTNFS WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM �REAKEflS <br />fi00F DRAINS -- FAINLEADERS <br />SINK �SERVICE — OAR. ETQI <br />SUBTOTAL <br />PERMI7 <br />TOTALFEE <br />SIDE VAFD SETBACK STREET SET�oCH <br />USE ZGNE LOT AREA <br />TYPEOFCONST. OCCL'PAM1CY GROUP <br />SIZE OF BLDG. NO. OF STORIES <br />1. ENVIFONMENTAL CHF.fK LIST <br />2. BUILDItlG PLANS <br />3. FIRF HV�RANT <br />4. FIRE PROTEC710N SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTALIMPACTSTATEMENT <br />D. HEALTH DISTRICT <br />APP�JCATION ACC.�Y PLANSCHECKED BY <br />REAR 1'ARD SET�ACK <br />❑YES <br />NO. O <br />MAX. <br />I HEREB'! CERTIFY THAT I HAVE READ ,4ND EXAMINED THIS AP- <br />PLICATION AND KNUW THE SAM[ TO BE TRUE AI�ID CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WIIETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOl' <br />PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANC[L'f HE PRO� <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR/E O]F CCNTPRCTOR OF FUtMOPIZ D FGENi / DAiE <br />i� //. /�.�7. �.� \��/it�.r nnw.r!/ �.Z��.rJ�B� <br />TYPE OF <br />AIR COND. UNITS — H <br />REFflIGERATION 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 />WALLHEATERS—PT.U. M <br />UNIT HEATENS — B.i.U. M <br />VENTILATION FAN <br />STOVE <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTV <br />_ SUBTOTAL <br />PEqM1T <br />TOTAL FEE <br />NBER <br />F[E <br />FEES VALi <br />5 <br />U.B.C. <br />SEC.303 <br />FEE <br />RECEIPT NO. <br />WHEN PqOPERLY VALIDATED (IN THIS SPAGE�/TF{I$�IS YOU�9 REflMlll O O � � <br />1 !8 yUUU <br />� <br />,�� .��n i�^(,I�� <br />APPR. POR ISSUANCE BY , , , �, �� ,� �i� ��! �'" <br />i' ° '.� <br />� � i <br />� <br />