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The Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />-,ONSTRLICTION <br />PERMIT <br />PERMIT NO. 12537 <br />❑ COMBINATION FX BUILDING MECHANICAL CJ PLUMBING <br />OWNER MAIL ADDRESS CITY PHONE <br />City of Everett 2702 Hoyt 259-8701 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICFNSE t <br />C. Walter Smith 3815 Smith Street Everett 98201 259-7257 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />0 NEW 0 ADDITION 0 ALTERATION XR REPAIR 0 DEMOLITION O FENCE 0 SIGN 0 WOOD STOVEIFIREPLACE INSERT <br />$ 23,831.50 <br />Reroof, Insulateand Repair <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <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 CONTRAC R OR AUTHORIZED AGENT DATE <br />X 10/10/83 <br />LEGAL DESCRIPTION OF PROPERTY !SHOW BELOW OR ATTACH FOUR C^PIESI <br />LOT —BLOCK —OF <br />JOB ADDRESS <br />2702 Hoyt <br />PLUMBING <br />MEC ICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATIO4 UNITS — H.P. EA, <br />LAVATORY (WASH BASIL I) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHESWASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />;,OVE — WOOD <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUBTOTAL f <br />SUB TOTAL S <br />PERMIT $ <br />PERMIT S <br />TOTAL. FEE $ <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET 'SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK 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 />$23,831.50 <br />164 <br />So <br />SIZE OF SLOG. <br />ND. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />- <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />YES NO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.O.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />1G4 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIBSfjCE1 THISf51Y0UBIPV1oIT_ r} <br />SJ $S 17 L ii II ,1 U V U U L.0 <br />YOUR RECEiPTw <br />'CHANK YOU <br />GRADING <br />B5. . <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />OCT b 3 <br />ADDRESS FILE <br />