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t11eL1��T�aF ^.ONSTRUCTION -� <br /> everett PERMIT pERMIT NO. 09405 <br /> CITY HALL 259�8745 � <br /> EVERETT,WA 98201 ❑ COMBINATION 7E]�i BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNER MAi�qODRE55 CITY ZIP PHONE <br /> C. H. Oberholtzer 1406 Grand Everett 98201 252-0775 <br /> ARGIIRELT OR pE51GNER MAIL AD�PE55 CRY ZIP PIIONE <br /> G[NERAI CONTRACTOR IAAi�ApDRESS CIiY ZIP PNONE II:ENSE♦ <br /> Same <br /> MECMANICALCONLRAC70R MAILAO�RE55 QTY ZIP PHONE LICE45E1 <br /> PLUMBINGGONTflACTOR MAILA�ORE55 CITV ZIP PHONE �ICENSEI <br /> GlASS OF WpRK <br /> ONEW ❑ADOITION ❑A�TERATION QC1A[PAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> VALUATION OF WOFK <br /> S 1SOO.00 <br /> DESCRIBE WORK <br /> Re-roof Shake <br /> raovoseo use oF auiiou+� <br /> single family residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> LEGAL pESCRIPTIOV OF PROPERTY�SMOW BELOW OR ATiAGH FOUNCAPIE'u) PLICATION AND KMOW THE SAM[ TO BE TRUE P.ND CORRECT. <br /> 3-4 296 Everett Div. R ALL PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS <br /> ior e�ocK_ov TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO• <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> C ST U TION T PERFOFMANCE OF CONSTRUCTION. <br /> JOB R�ORESS SIGNAiU F C NT R F 1110RIZED AGENT qATE <br /> 1406 Grand X 6/19/81 <br /> PLUMBING ME ANICA <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSFT fTOILETI AIR COND.UNITS—H.P.EA, <br /> BATM7U8 REFRIGERATION UNITS—H.P.EA <br /> LAVATORY�WASH BASIN) BOILERS—H.P.EA. <br /> SNOWEfl GAS fIHED A.C.UNITS—TpNNAGE EA. <br /> KITCHEII SINK 8 DISP. FORCED AIR SVSTEMS—B.T.U. M EA, <br /> DISHWASHER R'ALL HEATERS—B T.U. h1 <br /> LAUNDFlY TRAV UNIT HEATERS—�B.T.U. M <br /> CLOTHES VlASHER EVAPpRATIVE COOLERS <br /> WATER-IEATEfl CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKII7G FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— GF.M. <br /> VACUUTA OREAKERS SiOVE <br /> ROOF CRAINS—RAINLFADERS METAL FIREPLACE&C111MNEY <br /> SIRK(ScRVICE—BAR,ETC.) <br /> SUB TOTAL SUB TOTAL S <br /> PEPMIT S PEHMIT S <br /> TOTALFEE f TOTALFEE S <br /> SIDE VARD SETBACK STREET SET6ACK REAR VARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIP7 N0. <br /> USE ZONE LOT AREA VACANT SITC <br /> ❑YES ❑NO FEES VALUATION FEE <br /> 7YPE OF CONST. OCGUPANCY GROUP N0.OF DWELLING UNITS <br /> BUILDING S1S00. 00 25 00 <br /> SIZE OF BLDG. N0.OF S?pRIES MF%.OCC.LOAD <br /> PLUMOING <br /> FIRE ZONE BASEMENT FIRE SPRINKLEPS <br /> REOUIRED � MECHANICAL <br /> ❑VES llNO <br /> APPROVALS BY DATE �THER <br /> 1. ENVIRONMENTALCHECKLI57 <br /> PENALTY U.B.C. <br /> 2. BUILDING PLANS SEC.303(a) <br /> 3. PIPEHVDRANT TOTAL 25 00 <br /> 4. FIRE PROTECTION SYSTEhf PERMIT VALIDATION <br /> WHEN PROPERLY VALIDAiED(IN THIS SPACE)THIS IS ypUR PERMIT <br /> 5. GRADING (,[� <br /> � : - n - ('. (1 V <br /> 6. DRAINAGE ' � ' � � � � �. ��: .J -- <br /> ). ENVIRONNENTAL IMPACT STA7EIAENT � <br /> B. MEALTH DISTRICT � <br /> nm��,_�. ;' -. (� <br />