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U)e Evergreen <br />CITY OF <br />(wexrett <br />259-8745 <br />v� 'INSTRUCTION <br />PERMIT <br />PEPMIT NQ:. 20395 <br />❑ DEMOLITION C COMBINATION �JBUIL'DING ❑ MECHANICAL '❑ PLUMBING ❑ SIGN <br />OWNER MAL ADDRESS r-- CITY ZIP PHONE <br />_ Roy and Ina Ccttrell 2117 Lincoln _ Everett 98703 339-3390 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />Owner _ <br />MECHANICRL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION (] REPAIR Cl DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORT— <br />S 200.00 <br />DESCRIBE WORK <br />Inspect :deck. <br />HEAT SOURCE <br />❑ ELECTGBCITI ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSEO I. Si OF BUILDING <br />Deck <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 nc COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAT OF COE'TRACT . AUTHOAp RIZED AGENT. OR OWNER DATE <br />X L/'(�i�cR/'�t fLP 7 <br />LE PAL DCiCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />-OT __ BLOCK _ OF <br />i <br />JCB ADDRESS <br />2117 Lincoln <br />.. PLUMBING <br />MECHANICAL <br />N.O. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />—YPE OF F.GUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNOLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BCILEP^ — B.T.U./H P. <br />_ <br />SHOWER <br />GAS FIRED ABC. UNITS —B.T,'1. <br />_ <br />KITCHEN SINK S DISP, <br />FORGED AIR SYSTEMS — 8.TU. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS —BT.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PRE% ENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, F'i C.) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />S <br />• <br />FRONT SETBACK <br />PERMIT <br />TOTALFEE <br />REARbETBACK SIDE <br />S <br />S <br />SETBACK <br />PERMIT <br />TOTALFEE <br />PLAN CHECK NUMBER <br />12.3 <br />�r <br />^OftWATIONtj <br />R <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑No <br />FEES <br />I <br />FIR FEE <br />BUILDING <br />n <br />n2 <br />.SO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />L h <br />SIZE OF BLDG. <br />NO OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES El NO <br />_ <br />INVESTIGATION FEE <br />Sec. 304(e) <br />STATE BUILDING SURCHARGE <br />I <br />In <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />S.H. <br />PLANSCHECKED13Y <br />AMR. FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />"— <br />_ <br />TOTAL <br />I18 <br />50 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT <br />rn <br />M <br />G7 <br />ADDRESS FILE <br />