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the Evergreen <br />'- CO" STRUCTION <br />OF <br />cm of <br />evel�+ eft <br />PERMIT <br />PERMIT NO.07181 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 <br />❑ COMBINATION &BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />OWNE%ichael <br />MIILADDRESS CITY <br />ZIP <br />PHONE <br />XKXKM J. Marleau 9511 Holly Drive <br />98204 <br />353-7747 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE / <br />same <br />MECHA141CAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE# <br />PWMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE UGENSEI <br />CLASS OF WORN <br />❑NEW ❑ADDITION ❑ALTERATION H}HEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />$1,000.00 <br />re -roof shake <br />PROPOSED USE OF BUILDING <br />repair single family residence <br />I HEREBY CERTIFY THAT 1 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 />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHUn;TY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER SLATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE NRAUTHORI�lvYiYi� DATE <br />X � 1/29/80 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />6 Walters Manor <br />LOT BLOCK. —OF Walters <br />JOB ADC 'S5 <br />821 $$X$7[kRSX 9511 Holly Drive <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET QOILET) <br />AIR COND. UNITS — H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />_ <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNT/M <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />S <br />1 <br />f TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHFCK NI'MBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SI''E <br />OYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />140. OF DWELLING UNITS <br />_ <br />BUILDING <br />5 1,000. <br />10 <br />00 <br />SIZE OF BLDG, <br />NO. OF STORIES <br />MAX. (\x. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />F1lE SPRINKLERS <br />REQUIRED <br />DYES LINO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303(a) <br />2. BUILDING PLANS <br />TOTAL ,•1 <br />10 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />16 6 i S 10.00 -- <br />' • r <br />YW A ..RE�E f ff <br />tJ- <br />j <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPAC. STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />