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"eet'cTvotl `.`p'ONSTRUCTIOF' <br />everett PERMIT PERMIT NO. 12684 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑ COMBINATION ®C BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />- crinnmm 11TA n09nA ZA7-An'4n <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE# <br />Same CITY ZIP PHONE LICL NSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />LICENSE <br />PLUMB:NG CONTRACTOR <br />MAILADDRESS CITY ZIP PHONE <br />CLASS OF WORT( <br />❑ NEW ❑ADDITION RIXALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑ WOOD STOVEIFIREPLAGE INSERT <br />VALUATION OF WORK <br />$5,000.00 <br />-- -A ry.+ +n 1.1_tnnm <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Single family residence <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELO'.Y OR ATTACH FOUR COPIES) <br />6 <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />Walters LOT _ BLOCK -OF Manor <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE F NTR THO D NT DATE <br />TOR AU <br />JOB ADDRESS <br />X <br />9511 HOLLY DRIVE <br />_ <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 (TOIL <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA, <br />SHOWER <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />KITCHEN SINK & DISP. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT — C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE — WOOD <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />- v <br />HEAT PUMP <br />- .- <br />SUBTOTAL $ <br />SUB TOTAL S <br />PERMIT $ <br />PERMIT i <br />TOTAL FEE <br />$ <br />TOTAL <br />FEE S <br />SIDE YARQ SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />IPT NO. <br />FEE32.83 <br />51 <br />20' <br />201 <br />83/12684 <br />RE�I01 <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />R-3 <br />EYES xNO <br />TYPE OF CONST- <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$5 000. <br />50 <br />50 <br />V-N <br />R-3 <br />1 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT <br />RIEOUSREC KLERS <br />MECHANICAL <br />DYES LINO <br />APPROVALS <br />BY DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />50 So <br />TOTAL <br />3. FIRE HYDRANT <br />PERMIT VALIDATION <br />4. FIRE PROTECTION SYSTEM <br />WHEN PROPERLY VALIDATED (IN THI$ SEACF,I THIS T j{�F¢PEAMIT__� <br />4[ 4 U �J U 7 �J <br />LIC <br />C\ <br />YOUR RECEIPT.' — <br />THANK YOU <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACTSTATEMENT <br />S. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />stg <br />jaf <br />lnc <br />15 My S 5 <br />ADDRESS FILE <br />__■ <br />