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1. <br />the Evergreen <br />O CITY <br />F._ "ONSTRUCTION <br />everett <br />PERMIT <br />PERMITNO. <br />13039 <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />❑ COMBINATION Q BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />OWNER <br />GEORGE FOSTER <br />MAIL ADDRESS CITY <br />B1826 RAINIER AVE. EVERETT 9B210 <br />ZIP <br />PHONE <br />252-6004 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />_ <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 4 <br />SENIOR SERVICES SNO. CO. 3402 112th St. W EVERETT 98204 355-1112 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 4 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 0 <br />❑ NEW Cl ADDITION ❑ ALTERATION 13 REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEJFIREPLACE INSERT <br />f 35 <br />RFNOVF. AND RPLACF. FRONT AND RF.AR PLIRCH ANO CTF.PR <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 ANDCORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUMETO GIVEAUTHORITY TOVIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUC ION. <br />SIGN:.f JRE 0 TRACTOR OR AUTHORI AGE DATE <br />X 2/27/84 <br />LEGAL DESCRIPTION OF PgOPERTYISHOW BELOW OR ATTACH FOUR COPIESI <br />LOT19=29LOCK 362 DF_ EVERETT DI_V. P <br />S 1/2 Lot 20 <br />-- <br />JOB ADDRESS <br />1826 RAINIER <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />F 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 d 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 />VENTILATION FAN <br />DRINKING FOUNTAIN <br />I 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 />HEAT PUMP <br />SUB TOTAL f <br />SUB TOTAL f <br />PERMIT f <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />Z;YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ 350.00 <br />lO <br />OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />—YES :.NO <br />MECHANICAL <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 PLANS <br />TOTAL <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACa I.THIS ISC TI 11FRQID <br />CC LL 0 44 J' UU II ILT� uu M <br />C3 <br />� <br />YOUR R C [ i P� <br />-CHANK YOU <br />& GRADING <br />B. DiiAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />1C <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />1C <br />27FEB o4 <br />ADDRESS FILE <br />