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n11 1J1'ol YJ <br />EVERET I. WA 98201 COMBINATION LLl BUILDING <br />OWN L�,r-qa,pG MAILADDRFSS <br />-JavvYes' <br />ARCHITECT OR U151UNER MAIL ADDRESS <br />�VYT mYC SSl Or1 �es icl y� aaa7 -7;,ks R*Y <br />ENERAL CON ACTOR J MAIL ADDRESS <br />❑MECHANICAL ❑PLUMBING PERMIT NO. <br />CITY ZIP PHON[ <br />�. SewFp% IV33 <br />CITY ZIP P.nNl <br />vc,-,-ft— yYa03 3S-5-3a00 <br />CITY i ZIP PHONE LICENSE I o l,e c�ec,cleJ <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />� st .. •. ZIP PHONE LICENSE I <br />I CLASS OF WORK <br />� <br />L�NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />5 C/a 000, — <br />DESCRIBE WORK <br />PROPOSED USE OF BUILDING <br />S I I IO D w Y� 5 icie 5 ce <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALI <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORT, WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE TO VIOLATE7G.rK OF <br />ONS <br />ANY O RITY HERO STATE ORLOCAL L WRREGULATINGCONSTRCANCEL THEIUUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />IECALDESCRIPTION <br />2QIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT 1BLOCK—oF in a a P . <br />pp // <br />Ve cre ee/ Vol- °p O-T• 4t�, , k7 <br />CcrKI .� y, 'rs - <br />LOB ADDRESS <br />_ <br />// D - e r5 o rL D r i v e- — (✓ey-c'f%— <br />X <br />PLUMBING <br />MECHANICAL ' <br />NO. <br />_3 <br />_3 <br />LL <br />TYPE OF FIXTURE <br />WATER CLOSET JOLIET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />FEE <br />0� <br />Qp <br />(J' D <br />NO. <br />TYPE OF EQUIPMENT <br />AIR COND. UNITS —HP EA <br />REFRIGERATION UN17S—H P. EA <br />BOILERS—H.P. EA ' <br />CAS FIRED A.C. UNITS —TONNAGE EA <br />TEL <br />DISWAKITCHEN SINK 6 DISP. <br />L <br />LAUNDRY <br />LAUNDRY TRAY <br />T <br />CLOTHES WASHER <br />WATER HEATER <br />�D <br />00 <br />O <br />o2. <br />FORCED AIR SYSTEMS—B.T.U. M En <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT— C.F.M. <br />STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />SOD <br />$ <br />0 <br />d0 <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS —RAINLEADERS <br />SINK (SERVICE —BAR, ETC) <br />SUB TOTAL <br />PERMIT $ <br />SUBTOTAL $ <br />PERMIT 5 <br />Qri <br />SIDE YARD SETBACK <br />TOTAL FEf <br />STREET SETBACK <br />S UD <br />REAR YARD SETBACK <br />TOTAL <br />PLAN CHECK NUMBER <br />Oc=>I <br />FEE f 0 <br />PLAN CHECK FEE <br />Ft RECj IPi_NgB <br />33. 5� S <br />i' <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES XNO <br />FEES <br />VALUATION <br />FEE <br />TYPE <br />/..OF CONST. <br />OCCUPANCY CROUP <br />NO. OF QWELLING UNITS <br />BUILDING <br />Op y9n <br />SIZE OF BLDG. L <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />ICJ <br />cc) <br />FIRE ZONE <br />3 <br />BASEMENT <br />JA H <br />BEDROOMS <br />3 <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES NO <br />MECHANICAL <br />O <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />M <br />PENALTY <br />U.B.C. <br />SEC. 303(a) <br />2. BUILDING PLANS <br />3 FIRE HYDRANT <br />TOTAL <br />vo <br />A. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />�Q C, S7E10 AJC lip✓ el'T4 SOP:,TYi In,[) <br />r%✓J JSQ %'i:'.ti ✓YY ITY Nt: <br />S. GRADINGIEXCAVATION& CLEARINGIGRURRING <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 />V. �- <br />9.1.79 <br />