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, , <br /> lheErergreen - - C0�'STRUCTION � <br /> GTY OF . <br /> everett PERMIT PERMIT NO. OH33O <br /> CITY HALL 259�8745 <br /> EVERETT.WA 98201 � COMBINATION Q BUILDING � MECHANICAL ❑ PLUMBING <br /> OWNER MAILADDRESS CITY ZIP PMONE <br /> Bob Bertilson <br /> ARCHRECT OP DESIGNER MAIL ADDPE55 GITY Z�p PHONE <br /> GENEFAL CONTMCTOR MAI�ADDRE55 GiV Zlp PNONE LICENSE� <br /> Clifton L. Stout 1819 3rd Street Marysville 659-5367 <br /> MECNANICALCAryTflRCTOfl MRILADpRE55 CIIY ZIP PMONE UCENSEI <br /> ST OU TX L315TM <br /> PLUMBING CANTNACTOR MAIL ADDRESS GITY ZIP PHONE LICENSE� <br /> CU55 OF WORK <br /> ❑NEW ❑ADDITION ❑ALTERATION L�XEPAIR ❑DEMOLI710N ❑FENCE ❑SIGN ❑CaARAGE <br /> VALURTION OF WORK <br /> : aoo.ou <br /> DESCPIBE WONK <br /> re-roof composition <br /> PROPOSED USE OF BUILDING <br /> duplex I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> LECa�L DESCRIPTION OF PROPERTv�SNOW BELOW OR ATTACH POUR COPIES� PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> 2 226 Su lemental Plat of ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �o� BLOC1�_OF PP TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> urc i an a oures HEREIN OR NO7. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br /> V�SIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR RMANCE OF CANSTRUCTION. <br /> .pB A D E SIGNATURE OF CA�TRqLT OR12ED ENT DATE <br /> Q�� Grand Avenue X B/23/80 <br /> PLUMlINO MECHANI AL <br /> NO. - TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILEn AIR CAND.UNITS—H.P.EA. <br /> BATHTUB REFRIGEPATION UNITS—H.P.E.v <br /> LAVATORV(VJASH BASIN) BOILERS—MP.EA. <br /> SHOWER GAS PIPED AC.UNITS—70NNAGE EA. <br /> KITCHEN SINK d DISP. FORCED AIH SVSTEMS—B.T.U. M FA. <br /> DISHWASHER � WALL HEATERS—B.T.U. M <br /> UUNDRV TRAV UNIT HEATERS—B.T.U. M <br /> CLOTMES WASHER EVAPORATIVE COO�ERS <br /> WATER HEATER CLOTIIES DRYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN RAN�E HOOD <br /> FLOOR DRA�N AIR HANDLING UNIT— QEM. <br /> VACUUM BREAKERS STOVE <br /> ROOF DMINS—RAINLEADERS METAL FIREPLACE 8 CHIMNEY � <br /> SINK(SERVICE—BPq,ETC.1 <br /> j <br /> �, SUlTOTAL SUlTOTAL S <br /> � . PEpM1T f PENMIT t � <br /> TOTAL FEE t TOTA�FEE � <br /> � SIUE YMD SETBACK STREET SEfBACK REqR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE � <br /> FEE RECEIPT NO. � <br /> , USE ZONE LOT AREA � VACANT SI7E �� <br /> . ❑YES ❑NO FEES VALUATION FEE <br /> , T'PE OF CONST. pOCUPANCY GROUP N0.OF DWELUNG UNIiS I <br /> BUILDING 5800.00 I$ SO <br /> SRE OF BLDG. NO.OF STORIES MAX.OCC.LOAD <br /> PLUMBING <br /> � FIRE ZONE BNSEMENT FIRE SPRINKLERS <br /> REOUIRED MECHANICAL <br /> OYE6 �NO <br /> �� AMIqVALB �Y pATE OTHER � <br /> 1. ENVIRONMENTAL CHECK LIST <br /> �� 2. BUILDINO PUNS �NALry SEC.303(a) <br /> 3. FIRE HYDRANT TOTAL 14 S O <br /> 1. FIRE PR07ECTpN SVSTEM PEIIMIT VALIDATION <br /> 5. GRADING WHEN PROPERLY VALIDATED(IN THIS SPACE)THISt IS YOUR PEHMIT <br /> 8. DRAINAGE H I � J � O I �. S O � � <br /> 7. ENVIRONMENTALIMPACTSTATEMENT m <br /> e. HEALTHOISTRICT 4`q ;� (� RGCE1� <br /> APPLICATION ACC.BY PLANS CHECKED BY APf'R.FOR ISSUANCE BY I f�I P�I�K Y O U � <br /> 1 3 s� 8 0 <br /> ADDR[SS FILE <br />