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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />C^NSTRUCTION <br />PERMIT <br />❑ COMBINATION ❑ BUILDING ER MECHANICAL <br />PERMIT NO. 08143 <br />RkPLUMBING <br />OWNER MAIL ADDRLSS CITY ZIP PHONE <br />Robert M. Olson 3408 Gorin Place 98204 337-2322 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />Same <br />MECHANICAL CONTRACTOR NAIL ADDRESS CITY ZIP PHONE LICENSE) <br />PLUMBING CONTRACTOR MAIL ADDRESS C" ZIP PHONE LICENSE <br />— — ❑NEW DADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />f <br />PRCIPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAMF TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAtTTUREp�qCO 7 TOR OR AUTHORIZED AG NT DATE <br />X �1Y 8/21/80 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />?001�2S RLaK 433E Everett <br />JOB ADO LESS <br />2118 Hoyt Avenue <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />2 <br />WATER CLUSET(TOILET)4 <br />00 <br />AIR COND. UNITS — H.P. EA. <br />1 <br />BATHTUB <br />2 <br />00 <br />REFRIGERATION UNITS —H. P. EA <br />2 <br />LAVATORY WASH BASIN) <br />4 <br />00 <br />BOILERS — H P. EA, <br />1 <br />SHOWER <br />2 <br />00 <br />GAS FIRED AC. UNITS —TONNAGE EA. <br />KITCHEN SINK 6 DISP, <br />FORCED AIR SYSTEMS — B T U. M EA. <br />DISHWASHER <br />WALL HEATERS — B T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS —B.T U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />URINAL <br />CLOTHES DRYERS <br />VENTILATION FAN <br />2 <br />00 <br />DRINKING FOUNTAIN <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 A CHIMNEY <br />SINK (SERVICE — BAR. ETC) <br />SUBTOTAL <br />12 <br />00 <br />SUBTOTAL f <br />2 <br />00 <br />PERMIT <br />f <br />PERMIT <br />It <br />TOTAL FEE <br />f1 <br />9, <br />on <br />TOTAL <br />FEE f <br />SIDE YARD eETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDG. <br />N0. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />12 <br />00 <br />FIRE ZONE <br />BPSEMENT <br />FIRE <br />EYES <br />SPRINKLERSKLERS <br />❑NO <br />MECHANICAL <br />2 <br />00 <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U B C. <br />SEC. 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />14 <br />OO <br />3, FIRE HYDRANT a. <br />C FIRE PROTECTION SYSTLIM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED RN THIS SPACE) TIIIS IS YOUR PERMIT <br />67 1 4 So 12.00 <br />r <br />YOUR RECEIPT c <br />T l FY I V � YOU <br />I <br />5. GRADING a <br />6. DRAINAGE J <br />7. ENTAL IMPAC► STATEMENT <br />B. HEAL D RICT <br />FS APPLICA%IBN ffC. BY <br />O m <br />LANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />v <br />2 2 Auc 8 0 <br />ADDRESS FILE <br />