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the Evergreen <br />CITY OF F <br />everett <br />CITY HALL 25"745 <br />EVERETT, WA 98201 ❑ COMBINATION <br />"ONSTRUCTION <br />PERMIT <br />FYX MECHANICAL <br />PERMIT NO. <br />❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHLNE <br />Gordon Sutherland 3225 Pine Everett 98201 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE A <br />Natural Gas Equipment Co. <br />Inc. 1625 East Marine <br />View Drive <br />98201 <br />258-2441 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE A <br />❑ WOOD STOVEIFIREPLACE INSERT <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING TI1lZ I. fPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES 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 />PERFORMANCE OF CONSTRUCTION. <br />SIGNIA,FUREOIF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X &4 LL1.' ( 8/16/84 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIESI <br />LOT -BLOCK -OF <br />JOB AOORESS <br />3225 Pine <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 EA. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER _ <br />WALL HEATERS — B.T.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 />URINAL <br />VENOLATION FAN <br />DRINKING FOUNTAIN <br />RANG, HOOD <br />FLOOR DRAIN <br />AIR HAN )LING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE —WOOD <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />1 <br />Water Heater <br />4 <br />50 <br />SUBTOTAL i <br />SUB TOTAL $ <br />4 <br />50 <br />PERMIT $ <br />PERMIT f <br />10 <br />00 <br />SIDE YARD SETBACK <br />TOTAL FEE <br />STREET SETBACK <br />$ <br />REAR YARD SETBACK <br />TOTAL <br />PLAN CHECK NUMBER <br />FEE 5 14 50 <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />_:YES -]NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLOC. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ❑NO <br />MECHANICAL <br />14 <br />50 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING F1 ANS <br />3. FIRE HYDRANT <br />TOTAL <br />14 <br />50 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS B YQU P QQIT <br />t 2 J 4 f O I �,(f —� <br />(1' <br />5. GRADING <br />6. DRAINAGE <br />T. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />