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Me Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />�--,FONSTRUCTIOP" <br />PERMIT PERMIT NO. 12661 <br />❑ COMBINATION )(91 BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />EVERGRE '"O <br />Fvaratt WA 98203 <br />355-9506 <br />rurcNr I P TP T RS0N5329 <br />AROHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL AUDRE55 <br />CITY <br />ZIP <br />PHONE <br />LICENSE 4 <br />ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE 0 <br />PLUMBING CONTRACTOR <br />MAIL <br />CLASS OF WORK <br />❑ NEW ❑ADDITION ❑ ALTERATION )[R REPAIR ❑DEMOLITION ❑FENCE q SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />s 2,500.00 <br />la.11 fnundatinn <br />PROPOSED USE OF BUILDING <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Residence <br />1 HEREBY <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />LEGAL DESCRIPTION OF PROPERTY(SHOW BELOW OR ATTACH FOUR COPIES) <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT27=308LOCK__OF Pinehurst <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCT( <br />SIGNATURE OF CONTRACTO OR A A NT DATE <br />JOB ADDRESS <br />X 11 4 83 <br />1917 Pinehurst <br />PLUMBING <br />MECHANtfAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <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 />GAS FIRED A.C. UNITS — TONNAGE EA. <br />SHOWER <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />KITCHEN SINK& DISP. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING 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 />N F.AT PUMP <br />SUBTOTAL <br />S <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑YES ❑NO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />52,500. <br />38 <br />50 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />IRED <br />MECHANICAL <br />OTHER <br />YES ;, NO <br />APPROVALS <br />BY <br />DATE <br />I. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />-- <br />TOTAL <br />38 <br />50 <br />3, FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5.GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IN THIS 9 ACE) THISdSffl PF blff <br />Y b <br />1� <br />CV <br />YOUR R E C E I PT Y 1 <br />THANK YOU <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />- 7 KOV 8 3 <br />ADDRESS FILE <br />