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JOtVS�RUC�I� �' <br /> �����`'� PER� �T PERMIT N0. 13� � 7 <br /> CITV HALL 259�87d5 <br /> EVEqETT.WA99201 � COMBINAiION CX� BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> . 01VNEF MAIL A�DRE55 QTT ZiP PHONE <br /> MAR70RIE WALKER 2519 SACKSON EVERETT WA 98201 <br /> APCHITECT OR DESiGNER MAIL ADORE55 CITY ZIP PMONE <br /> GENERAL CONiRAGTOR MAIL AODRE55 QTY 21P PMONE LILENSE� <br /> MECMAN�GAL CONiRAGTOR MAIL AO�RE55 CITY Z;P PMONE LICENSE x <br /> PWMBING L0IJTRACTOR MAIL AD�RESS LITY ZIP PNl>NE LICENSE M <br /> C1A55 OF WOPK <br /> ❑ NEb'J ❑ ADDITION ❑ ALTERATION 7QREPAIR ❑ LEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD 5T('�VEIFIREPLACE INSERT <br /> VA�UATION OF WORK <br /> i 5 8�0.�� <br /> DESCRIBE�.VORK <br /> Reroof - composition <br /> PPOPCS[0 USE OF BUILDING <br /> Residence I HERC-BY CEFTIFY THAT I HAVE READ AND EXAMIN�D THIS <br /> APPLICATION AND KNOW THE SAAd'c TO BE THUE AND <br /> LEGALOESWiPT:ONOFPROPEFTV�SHOYl�ElOYfORARACMFOUFGOPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �or_e�ocn_oF GOVEHNING THIS TYPE OF WORK WILL BE COMPLIED Wll'H <br /> WHETHER SPECIFIED HERF.IN OR NOi. THE GRANTING OF A � <br /> PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL TNE PIIOVISIONS OF ANY CTHER STATE OH � <br /> LOCAL LAW REGULATINC CONSTRUCTION OR THE <br /> PEFF�MANCE OF CQ�ISF!iF' ON. <br /> JODADpqFSS SiGNA REOFCONiFACTO R�UTHORIZE[l 4ENi �AiE <br /> 2519 JACKSON X rvc G 12 'g¢� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FcE N0. TYf�E OF E�UIPMENT FEE <br /> WATERCLOSETQOILET) AIA COND.UNITS— H.P. EA. <br /> 8AT1{TUB REFRIGERATION UI�ITS — H.P. EA. <br /> LAVATORY�WASHBASIN) BOILERS— H.P. EA. <br /> SHOWER GAS FIRED A.C. UNITS — TONNAGE EA. <br /> KITCHEM1 SINK 8 DISP. FORCED Alfl SYSTEMS— B.T.U. M EA. <br /> DISHVJASHEH WALL HEATERS— B.T.U. M <br /> LAUNORY TRAY UNIT HEATERS— B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLEFS <br /> WATER HEATER CLOTHES URYERS <br /> URINAL VENTILATION FAN <br /> OPINKING FOUNTAIN RANGE HOOD <br /> FLOON DRAIN AIP HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS SiOVE — WOOD <br /> ROOF�RHINS— RAINLEADERS METAL FIREPLACE&CHIMNEV <br /> SINK�SERVICE— BAR,ETQ) FIREPLACE INSERT <br /> HEAT PUMP <br /> SUB TOTAL S SUB TOTAL = <br /> PERMIT f PEflM1T S <br /> TOTAL FEE f TOTAL FEE S <br /> SIOE VAf�D SETBACK STREET SETBACK REAR YAR�SEfBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE — — <br /> YES . .NO FEES VALUA710N FEE <br /> TVPE OF CONST. OCCUPANC� GROUP NO.OF OWELLING 11NITS <br /> BUILDING S 600.00 14 SO <br /> SIZE OF BLOG. f�0.OF SiORIES MA%.OCC. LOAD -- <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS MECHANICAL <br /> " REOUIRED <br /> VES NO <br /> APPROVALS BY UATE OTHER <br /> 1 ENVIRONMENTAL CMECK LIST PENALTY U.B.C. <br /> 2.BUILDING PLANS SEC.303(a) <br /> 3.FIRE HYDRANT T�TA� 14 SO <br /> 4.FiflE PROTECTION SYSTEM PERMIT VA�IDATION <br /> I S.GRADING - WHEN PROPERLY VALIDATED(IN THIS SPAC,)TMIS�^Y0�15'PF�R�QIT_ _ ; �+ <br /> 6.DRAINAGE _ , � 1 1 �, <br /> 7.ENVIRONMENTALIMPACTSTATEMENT - � <br /> B.HEALTY,DISTRICT �,,,,�_ ��__.� ' <br /> APPLICP.T;ON ACC. BY PLANS CHECKE�BY APPR. FOR ISSUANCE BY ' . P�._�.!. ! I� 1 ' ' <br /> � . . . � <br /> . . . i-!�.._ . .. . � <br /> � . <br />