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OWNFR NARADDflE55 CITY :IP PHONE <br />F1oy0Tremmel I19 115th Street S.E. Everett 98204 353-9456 <br />AqCH�TECTORDE5IGNER MAILADOflE55 CITY 2iP PNONE <br />GENERAL CANTPACTOR MAIL FDORESS GtY ZIP PHOdE LICENS'c e <br />Same <br />MELMANiCPICCNTFAOTOR MAtLADORE55 GTY ZIP PHONE LICENSE/ <br />PLUMBINGCANTqACTOR MAILA�DRE55 CIN ZIP PMONE LIGENSE♦ <br />G1A550F WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR �DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VAWAiION OF WORN <br />S <br />�ESCRIBE WORK <br />demolish single family residence and storage shed <br />PROPOSED USE OF BUIIDING <br />single family residence I HEREBY CER?:'i' THAT 1 HAVE READ P,NO EXAMINED THIS AP- <br />LEGNLOESCRIPiIONOFPPOPERTY�SHOW BELOWORATfACHFOUPGOPtES; PLICATION AND KNOW THE oAMF. TO BE TRUE AND CORRECT. <br />1-2-3 16 Pinehurst Div. B ALL PROVISIJNS OF LAWS AND OftDINANCES GOVERNING THIS <br />wr eiocK_oF TYPE OF W('�iK WILL BE COMPLiED WITH WHETHER SPECIFIED <br />HEREIN OF NOT. THE GRANTING OF A PERM17 LOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF �NY O1�iiER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTIG.'J "vFi THE PERFORMANCE OF CONSTRUCTION. <br />JOB AD�RESS SIuNATURE OF CqNiRAGO� O.JTHOR!2ED AGENT DAiE <br />2428 Madison X � �-/ � � � 12/15/80 <br />PLUMBING MECHA ��AL � <br />OR ITEM � FEE <br />WATER CLOSET QOILET) <br />BATHTU6 <br />LAVATOflY (VJASH BASIN) <br />SHOWER <br />KIT: `!EN SINK B DISP. <br />DISHW! uHER <br />LAUNDRYTRAY <br />CLO7HE5 WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINR (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SIDE YARD 5'cTB. <br />USE ZONE <br />TYPC OF CONST. <br />SIZE OF BL�G. <br />FlRE ZONE <br />STREET 5'cTBACK <br />LOT AREA <br />OCCUPANCY GROUP <br />NO. OF STORIES <br />BASEMENT <br />flEAR YARD SETBACK <br />VACANT SITE <br />CJYES ❑NO <br />NO. OF DWELLING UNITS <br />MAJ(. OCC. LOAD <br />FIRE SPRINKLERS <br />REOUIRED <br />❑YES ❑NO <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HVDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. ORAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMEN7 <br />8. HEALTH DISTqICT <br />APPLICATION ACC. BV PLANS CNECKED BY APPR. FOR ISSUANCE BY <br />NO.' TYPE OF EQUIPkiENT <br />AIR CqND. UNITS — H.P. EA. <br />.REFRIGERATION UNITS — H.P. EA <br />BOILERS — H.P.EA. <br />GAS FIflLD A.C. UNITS — TONNAGE LA. <br />F09CED AIR S�STE�dS — B T.U. M <br />WALL HEATEFS — �.T.U. M <br />UNIT HEATEf7S — B T.U. 1.7 <br />EVAPORATIVE COOLENS <br />CLOTHES DRYERS <br />AIR HANDUNG UNIT — <br />SUB TO7AL <br />GF.M. <br />PLAN CHECK NUMBER I PLAN CHECK FEE <br />FEE I �ECEIPT NG. <br />$ <br />PENALTY U.E.C. <br />SEG 'sJ3 (a) <br />TOTAL O 0 0 0 <br />PERMII' VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPA�E)�Tyl$,IS VOU�1 F,'�HMIO. O O � � <br />Ib VU <br />� <br />`... r..C:l;� <br />, r... <br />r�i V �� 7 <br />� , , �..�C.♦ � <br />ADDRESS FILE <br />I ti GEC E 0 <br />