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lheEverRreen ,i �ONSTRUCTIOA � <br /> Ciiv OF <br /> everett PERMIT PERMIT NO. 12792 <br /> CITY NALL 259A765 <br /> EVERETT,WA 98201 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING <br /> OWNEF MAIL AOUFE55 CITY 21P PHONE <br /> WILLIAM H. KALOGER 2230 E Grand Ave Everett l9A 98201 339-1188 <br /> ARCMITECT OR OESIGNEP MAIL AODRE55 CITY ZIP PNONE <br /> GENERAL GOHTR�GTOR MAIL qUDRE55 CITY 21P PHOt1E LICENSE I <br /> MEGHANICRICONTR�CTOR MAILADDRE55 CITY ZIP PHONE LICENSEI <br /> Same <br /> PIUMBING CONTPRCTOR MAIL ROORESS CITY 21P PMONE IICENSE� <br /> GL�SS OF WORN <br /> O NEW ❑ ADDITION O ALTERATION ❑REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN LT, WOOD STOVFIFIREPIACE INSERT <br /> VAWATION OF WORK � <br /> S <br /> DE RIBE WO <br /> �nsta 1 wood stove <br /> PRpPo SEQU E OF BUILDING <br /> K251dence I HEREBY CEflTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE A�ID <br /> LEGAL DESCRIPTION OF PROPENTY�SMOW BELOW OR ATTAGM FOUR GOPIES� CORRECT. A!L PROVISIONS OF LAWS AND ORDINANCiES <br /> GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED V/ITH <br /> LOT_BLOCN_OF WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERM IT DOES NOT PRESUME TO GIVE AUi HORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OH <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMA E OF CONSTRUCTION. <br /> JOq/��q�SS�,. Grand Avenue SIG _ T C ROR THOH12EOAGENT DATE <br /> LL U �( 12��I83 <br /> PLUMBINO MECMANICAL <br /> N0. TYPE OP FI%TURE OR ITEM FEE N0. TYPE OF EGUIPMENT FEE <br /> WATERCLOSETITOILEn AIR COND.UNITS—M.P.EA. <br /> BATHTUB REFRIGERATION UNITS— H.P. EA. <br /> LAVATORV(WASH BASINI BOILERS— H.P.EA. <br /> SHOWER GAS FIRED A.C.UNI7S—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS— B.T.U. M EA. <br /> DISNWASHEH WALI HEATERS— B.T.U. �4 <br /> LAUNOHV TRAY UNIT HEATERS— B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STO\'E—WOOD <br /> ROOF DRAINS— RAINLEADERS METAI FIREPLACE 6 CHIMNEY <br /> SINK(SERVICE— BAR,ETC.) FIREPLACE INSERT <br /> HEAT PUMP <br /> SUB TOTAL i SUB TOTAI f <br /> PEflM1T f PERMIT f <br /> TOTAL FEE f TOTALFEE f <br /> SIDE YARD SETBACK STREE7 SETBACK REAR YA(iD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA �ACANT SITE FEES VALUIITION FEE <br /> I;YES ��NO <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING s <br /> S2E OF BLDG. N0.OF STORIES MAX.OCC. LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS MECHANICAL 1� S O <br /> REOUIRFD <br /> �,_YES C,NO <br /> APPROVALS BY DATE OTHER <br /> 1.ENVIRONMENTAL CHECK LIST PEYALTY U.B.C. <br /> SEC.303(al <br /> 2.BUILDING PLANS TOTAL 1� S O <br /> 3.FIRE HYDRANT � <br /> �.FIRE PFiOTECTION SYSTEM PERMIT VALIDATION <br /> WMEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT (�J <br /> S.GRADING 5 � 9 � $ 0 I 1. 5 0 - �i <br /> 6.DRAINAGE (�— <br /> 7.ENVIRONMENTALIMPACTSTATEMEN7 (V <br /> APPLICATION ACCTBY PLANS CHECKED BY APPR.FOR ISSUANCE BY �1 ' i i: R�C f_I PT `—; <br /> ' ; %.P;!: 1'C U <br /> ADDRESS FILE _ � �C �5 <br />