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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 9745 <br />EVERETT, WA 98201 <br />CONSTRUCTION <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />D <br />OWNER MAIL ADDRESS ZIP PHONE <br />Warren Wood 301 Madison 355-1879 <br />R1 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />-i <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Sno. Co. Builders 5606 Ever reen Way EV ER EB 301PH <br />z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />❑ COMBINATION <br />❑ BUILDING ❑ PLUMBING ❑ MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION yOF WORK <br />S 84= 2,000.00 <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />re -roof <br />PROPOSED USE <br />single family residence <br />MECHANICAL <br />—_ <br />TYPE OF cNERGY <br />❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW Oh ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />Sec. 6 Twp 28 Rge 5 <br />NO. <br />TYPED <br />FEE <br />AIR COND. UNITS-H.P.H.P. EA. EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />_ <br />BOILERS-H.P. EA. <br />1 <br />FORCED AIR SYSTEMS-B.T.V. MEA. <br />I <br />JOB ADDRESS <br />301 Madison <br />SPACE & WALL HEATERS - B.T.0 <br />UNIT HEATERS-B.T.U. <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />S <br />I <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />DISH WASHERS <br />1 <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />1 <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />I <br />SUB TOTAL S <br />I <br />KITCHEN SINKS & DISP. <br />1 <br />BAR SINKS <br />PERMIT $ <br />TOTAL FEE $1 <br />ROOFDRAINS —RAIN LEADERS <br />I <br />I <br />SHOWER BATHS <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONS TRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PRIVATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY THER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR I PERFORMANCE OF CONSTRUCTION. <br />2/5/79 <br />X <br />SERVICE SINKS <br />SUMPS —SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />1 <br />WATER HEATER$ —ELECTRIC <br />1 <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />1 <br />1 <br />SUB TOTAL <br />PERMIT $ <br />TOTAL FEE & <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIG <br />TR AT RE OF CONACTOROR <br />UTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YAROSETBACK <br />PLA CH CK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />BUILUIMG <br />5 2,000.00 <br />1 <br />20100 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. UCC. LUAU <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED <br />[:]YES ONO <br />- <br />MECHANICAL <br />M <br />I <br />SPECIAL CONDITIONS <br />OTHER <br />1 <br />PENALTY <br />SEC. BOB (a) <br />TOTAL <br />0 <br />PERMIT VALIDATION K` <br />W1IEN PROPE RLY VALIDATED (IN THIS 1�T. ( IS YOUR PE HMIT <br />C? R REa <br />N'PLICAl10N ALCEPILD HY <br />PI ANSCHECKLO by <br />APPROVED Foil ISSUANCI aYIS <br />ADDRESS FIL` <br />