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everen <br />CITY HALL 259-8745 <br />EVERETT, WA 9B201 <br />PERMil' <br />❑ COMBINATION 127BUILDING ❑ MECHANICAL <br />PERMIT NO. 09420 <br />❑ PLUMBING <br />OWNER <br />MAIL ADDRE55 <br />CITI <br />ZIP <br />Gregory Vlastelica <br />2715 Grand Avenue <br />Everett <br />98201 259-1670 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />nTn' <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />'ITY <br />ZIP <br />PHONE LICENSE# <br />Everett Builders Inc. <br />5606 Evergreen Way <br />Everett <br />98203 <br />353-7161 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />EV <br />ER EB 301PH <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE # <br />I.IAJO V' nVnn <br />❑NEW ❑ADDITION �[Ij{LTERAT ON ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />s 1940.00 <br />DESCRIBE WORK <br />re -roof -Gutters <br />PROPOSED USE OF BUILDING <br />single family residence <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 />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUI COPIES) <br />�7-8 62PE Everett <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />LOr BLOCK —OF <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 />CONST UCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAT I OF(�C TOR OR AUTHORIZED AGENT DATE <br />JOB ADDRESS <br />715 Grand Avenue <br />X p- <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 />— <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 EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS--BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_. <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />�— <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />_— <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAW" ADERS <br />METAL FIREPLACE & CHIMNEY <br />_ <br />_ <br />SINK (SERVICE — BAD. Y' .J <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT S <br />TOTAL FEE <br />f <br />TOTAL FEE f <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 />DYES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CLNST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />s 1940. <br />32 <br />50 <br />_ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />--- <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />FIYES LINO <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1, ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303'a) <br />2, BUILDING PLANS <br />TOTAL <br />32 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />I I{ J ti 2, <br />N <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />a) <br />B. HEALTH DISTRICT <br />' 0 <br />' <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />i <br />� 1 L <br />ADDRESS FILE <br />