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Io <br />dTe Evergreen CITY OF CO NST R U CTI O P' <br />everett PERMIT PERMIT NO.11179 <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CIiY ZIP PHONE <br />Delbert Miles 2426 Grand Everett 98201 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY no o..nuc <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADCHESS <br />CITY <br />ZIP <br />Natural Gas Equipment <br />1611 East Grand <br />Everett <br />98201 <br />258-2441 <br />PLUMBING CONTRACTOR <br />MAIL ADh+ESS <br />CITY <br />ZIP <br />PHONE LICENSED <br />CLASS OF WORK -- <br />❑NcW ❑ADL'TION ❑ALTERATION ❑REPAIR ❑DEMOLITION El FENCE ❑SIGN ❑GARAGE <br />S <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIL DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIG? A URESF. CONTRACTOR OP AUTHORIZED AGENT DATE <br />X ("4E l_ (itYltL 10/26/82 <br />F� <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOr BLOCK_OT <br />JOB ADDRESS <br />2426 Grand <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <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 />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE FA. <br />KITCHEN SINK 8 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 — I11.0. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES ORYE:IS <br />_ <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.SM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />_ <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />_ <br />SUB TOTAL <br />SUB TOTAL S <br />4 <br />50 <br />PERMIT S <br />PEPMIT S <br />TOTALFEE i <br />TOTAL FEE S <br />14 <br />50 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />[]YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />4 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />14 <br />50 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />]YES E]NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />Us C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />14 <br />50 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />9295• L ' 7 i <br />; 8 �:4Q <br />' r- <br />• !n� fT C e )- <br />+ " O ' v? ^ LC C I r �J <br />THANK YOU <br />5GRADING <br />. <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />I <br />APPR. FOR ISSUANCE BY <br />_ <br />2 6 OCT 8 2 <br />ADDRESS FILE __ _�. <br />J <br />