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RUCTION <br />CITY OF ,.. <br />everett PERMIT <br />°MIT PERMIT N(3. 073.5 � <br />CITY HALL 259-8745 <br />EVERETT, WA 9B201 ❑ COMBINATION © BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS Cltt ZIP PHONE <br />James S. Irvine 17817 Wayne N. Seattle 98133 542-1826 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL OCNTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />Same <br />MECHANICAL 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 OPEMOLITION ❑FENCE ❑SIGN [I GARAGE <br />S <br />DESC411BE WORK <br />Demolish single family residence <br />78OK'SED U E OF UILRING <br />single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO B,? TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCEb COVERNIN THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES .JOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE P.iO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULhTIiNG <br />CONS RUCTION OR THE P - FORMANCE OF CONSTRUCTION. <br />SIGN UR OF CONTRACTOR ON AUTI IZ ENT Y DATE <br />X —1; . 3/24/80 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />31 �7�berson Park <br />LOT BLOC,Y/F <br />JOB ADDRESS <br />— 11401 West Ibberson <br />PLUMBING <br />ANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />INC. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />_ <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />_ <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 — v C F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />_ <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC) <br />SUBTOTAL $ <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT $ <br />_ <br />TOTAL FEE <br />S <br />TOTAL <br />_ <br />FEE $ <br />SILE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PIRN CHECK FEE <br />FEE RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VCLUATION <br />FEE <br />BUILTIING <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />$ <br />00 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZC' 5 <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ONO <br />MECHANICAL <br />— <br />— <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U R C <br />!IE: 303 (a) <br />2. BUILDING PLANS <br />TOTAL DO 00 <br />PERMIT VA, uATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />9 9 5 T $ 0 0 0. 0 0 -- _}; <br />r <br />(Y <br />YOUR RECG I PT <br />T,4AN K YOU <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />- <br />5. GRADING <br />6. DRAINAGE <br />_ <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC, BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />1 h AR 80 <br />t. <br />