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, <br /> theEvergreen �- CQ�y�TRUCTION r -� <br /> CITY OF <br /> ev�rett �'�RMIT pERM1T NO. OSO69 <br /> CITY h+4LL 259�8745 <br /> EVEREiT.WA 98201 ❑ COMBINATION �BUILDIN(i L� MECHANICAL ❑ PLUMBING <br /> OWNER MPILADpRE55 QTY ZIP PHONE <br /> Harry B. Metzger 307 Central Building Everett 98201 252-9851 <br /> ARCNIiECT OR DESIGNER MAIL ADDRESS CITY 2�P PHONE <br /> GENERAL CANTMCTOR MAIL ACDRESS CITY 21P PMONE LICENSE I <br /> Same <br /> MECHNNILALCANiMCTOP MAILADDflESS CITY ZIP PNONE LICENSE� <br /> PIUMBING fANTRACTOR IAAIL AOORESS CITY ZIV PHONE UCENSE� <br /> CUSSOF WORK <br /> ❑NEW ❑ADDITION ❑AL7ERATION }�REPAIR ❑DEMOLITION ❑fENf,E ❑SIGN ❑GARAGE <br /> WLUATION OF WORK <br /> f 1400. 00 <br /> OESCHIBE WORN <br /> re-roof ehake _ <br /> PROPOSEO VSE OF BUILDING <br /> Single family residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> LEWLOESCRIPTIONOFPNOPERTV�SNOWBELOWORATfPCNFOURfAPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. <br /> 5-6 Church 6 LaN.oures ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THI; <br /> ior�,Te�a�_oF _ TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIE'J <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NGT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE ORCANCELTHE PRO• <br /> VISI OF ANY OT S TE OR L L LAW REGULATING <br /> CO UCTION OR P R OR AN OF CONSTFUCTION <br /> SIGN U E F CONTFACTOR MOR ED AGE OATE <br /> '�B"�°��S crand X ,� � B/7/8o � <br /> PLUMe1N0 MECNANICAL <br /> NO. � TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(fOILEn AIR COND.UNITS–H P.EA. <br /> BATHTUB REFRIGERATION UNIiS–H.P.EA <br /> LAVATORY ASH BASIN) BOILERS–H P.EA. <br /> SHOWER GAS FIRFD A C.UNITS–TONNAGE EA. <br /> KITCHEN S�NK 8 DISP. FORCED AIR S�STEMS–B.T.U. M EA . <br /> � DISHW/SHER WALL HEAIERS–B.1.U. M <br /> LAUNDRY TRAY UNIT MEATERS–�.T.U. M <br /> CLOTHES WASHER EVAPORATIVECOOLERS � <br /> � , WATER HEATER CLOTHES DRYERS � <br /> URINAL VENTILATION FAN � <br /> � ORINKING FOUNTAIN RANGE HOOD � <br /> - � FLOOR DMIN AIR HANDLING UNIT– GF.M. <br /> , ' f VACUUM BREAKERS STO�E <br /> ROUF DMINS–fiAINLE4�ERS ME7AL FIRE�LACE 8 GHIMhFV <br /> � - - SINK SEPVICE–BAR,ETQ) — <br /> � � <br /> i <br /> � ��T�� SUB TOTAL t <br /> , � rE11MR i PERMIT i <br /> T�� TOTAL FEE <br /> � SIDE VARD SETBACK STqEETSETBRCK REAR VARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> � - FEE RECEIPf NO. � <br /> j <br /> � � USE 20NE LOT AREA VACANT SITE <br /> ' OVES ❑NO FEES VALUATION FEE <br /> �� � TYPE OF CONST. OCCUPANCY CaROUP NO.OF DWELLING UNITS - <br /> 1 <br /> � SV.EOFBLDG. NO.OFSTOHIES MA7(.00C.LOAD BUILDING S120O.00 12 00 � <br /> . ' PLUMBING � <br /> FIRE ZONE BASEMENT REOUI�D KLERS MECHANICAL <br /> C1YES ❑NO _ <br /> �pp�py� !Y DATE OTHER <br /> � � 1. ENVIRONMENTQCHECI(LIST pENALN U.B.C. <br /> � SEC.303(e) <br /> 2. BUILDING PIANS ' <br /> 3. fIRE HYDMNT T�u 12 00 <br /> 0. FIRE PROTECTION SYSTEM PE11MR VALIDATION <br /> WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADIN6 5 9 5 4 ,S O I 1. 0 0 �7 � <br /> 6. DMINAGE <br /> 7. ENVIRONMENTALIMPACTSTATEMENT � <br /> B. HEALTH DISTRICT YO U R R E C E I PT o <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY <br /> i;-I.ANK YO U <br /> ' = ) Auc 8 O. <br /> ADDF;ESS FILE <br />