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`," `,��'�`��� ^ONSTRUCTIOt� <br /> � <br /> everett PERMIT PERMIT NO. 12�H5 <br /> GTY HALL 259-87d5 <br /> [VERETT.WNB8201 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING � <br /> OWN[R MAILAODRE55 f,ITY ZiP PMONE <br /> PRISCILLA LEIDHOLDi 1611 Pine L'verett A'A 98201 252-1G49 <br /> ARCMITECT OR DESIGNER MAIL AO�RFSS QTY LP PHONE <br /> GENEPAL CONTHfCiOr: MRIL ADONESS CRY 21P PNONE LICENS[Y <br /> MELNANILAL CONTRPCTOR MAIL AOORE55 pTY 21P PMGNE UCENSE/ <br /> FLUMBING CONTRPGTOR MAIL AODRE55 CITY 21P PHONE UCE i5E 1 <br /> ClASS OF WORK <br /> �(I� NEW ❑ ADDITION ❑ AL7ERATION ❑REPAIR ❑ OEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/FIFEPLACE INSEFiT <br /> VALUAtION OF WORK <br /> S <br /> OESGRIBE WOFII <br /> Install wood stove <br /> PROPOSED USEOF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Residence APPLICATION AND KNOW 7HE SAME TO BE TRUE AND <br /> LEGAL DESCRIPTION OF PROPERiY�SH01Y BELOW OR ATTAGH FOUfl COPIESi CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> �or_eiocK_oF — WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERMIT UOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCEOFCONSTRUCTION. <br /> J00 ADDNE55 SIG RE OF CONTRAGiOR O�AUTN IZED AG1iN � �AIE <br /> 1611 Pine St. � a ; '�"�'��Z9�83 <br /> , <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILEn AIR COND.UNI75 — H.P.EA. <br /> BATMTUB REFRIGERATION UNITS— '•.P.EA. <br /> LAVATORY�WASHBASIN) BOILERS — H.P. EA. <br /> SHOWER GAS FIRE�A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEIdS— B T.U. M EA. <br /> DISHWASHER WALL NEATERS— B.T.U. M <br /> LAUNDRYTRAY UNIT HEATERS — BT.0 M <br /> GLO711ES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER C�OTHES DRYERS <br /> URINAI VENTILATION FAtJ <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT — G.f.M. Z <br /> 1 STOVE— W�OD C <br /> VACUUM BREAKERS �� <br /> ROOF DRAINS— flAINLEADEHS METAL FIREPLACE 8 CHIMNEY r. <br /> C: <br /> SINK(SERVICE — 9AR,E7C.) FIREPIACEINSERT ' <br /> HEAT Pl1MP <br /> H F� <br /> Sue TOTAL S 'J �,_ y ~� <br /> i SUB TOTAL s H �_ <br /> PEflMIT S PEHMIT S 1 U1 �: <br /> TO7AL FEE S TOTALFEE S p <br /> I SIDE YARD SETBACK STqEET SETBACK flEAR YAFO SETBACN PLAN CHECK NUMBER PLAN CHECH FEE �� � <br /> FEE RECEIPT NO. y � <br /> O _. <br /> USE ZONE LOT AREA VACANT SI1E FEES VALUATION FEE .a �, <br /> � YES '.:NO '- � �= <br /> 7vPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING 11NITS _. � <br /> BUILDING 5 ��i ( <br /> SIZE OF BLOG. NO.OF STORIES MA%.OCG LOAD i:.� t-: <br /> PLUMBING i-3 U <br /> K <br /> FIREZONE BASEMENT fIRESPRINKLERS NECHANICAL 1� SO O Y <br /> REOUIRED <br /> YES NO <br /> APPROVALS <br /> BY OATE OTMER � F� <br /> U.B.C. �� <br /> 1. ENVIRONMENTALCHECKL15T PENALTV SEC.30J�a) CC�� �'' <br /> 2.9UILDINGPLANE TOTA� 1� SO � �.; <br /> ?.FIRE HYDRANT �� <br /> a.FIRE PRO7EC710N SYS i EM PERMIT VALIDATION � <br /> W N EN PFOPERLV VALIDAT EO(IN THIB SZ AC�TMIS��'O�I�F�t�Q�T�_�.C�� <br /> S.GRAOING c .� � 11 I U p(�1 . �, <br /> 6.DRAINAGE � r- <br /> 7.ENVIRONMENTALIMPACTSTATEMENT TN <br /> B.NEALTH DISTRICT � _, �; }(�:V C I P 1� <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR. FORISSUANCE BY � <br /> ' � � .'. 11;; `�� ..iU <br /> r <br /> ! <br /> ;� n <br /> / � Sf_f" li J <br /> %��nh.«� i'I�� . <br />