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EVERETT. WA 98201 COMBINATION ❑ BiJll_DING 15 MECHANICAL <br />OWNER MAIL ADDRESS-- CITY ZIP PHONE <br />Esther Smit;T 4123 Hoyt Avenue <br />ARCHITECT OR DEHONER MAIL ADDRESS CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LK.ENSEV <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE) <br />Natural Gas Equipment <br />1611 East Grand <br />Everett <br />98201 <br />258-2441 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE) <br />El NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION <br />S <br />DESCRIBE V <br />PROPOSED USE OF BUILDING <br />- <br />I HEREBY CERTIFY T!+AT I 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 />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 />SIGNATURE OF, gyTPRATHORIZECWkj, DATE <br />X 3/2/81 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK —OF <br />JOB ADDRESS <br />4123 Hoyt Avenue <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLO iET (TOILET) <br />AIR COND. UNITS — H.P. EA. <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 />WAIL HEATERS—D.T.U. M <br />LAUNDRY TRAY <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 FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — PAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK(SERVICE — BAR. ETC.) <br />1 <br />Water HP ;ter <br />4 <br />50 <br />SUBTOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE S <br />TOTAI <br />FEE S <br />SIDE YARD SETBACK <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 />DYES LINO <br />FEES <br />VALUATION <br />_ <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />N0, OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES LNO <br />MECHANICAL <br />7 <br />50 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />7 1 <br />50 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOU P <br />II �J ( �, I , O <br />N <br />d <br />C>7 <br />165 <br />I <br />5. GRADING <br />6, DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />0 <br />