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CcogRUCTION h <br />��Y� <br />e''Vel'ett PERMIT P"MRNo- mmig. <br />CITY HALL 259-8745 <br />EYERETT. WA 99201 ❑ COMBINATION <br />CLCUILDINO <br />❑ MECHANICAL <br />❑ PLUMBING <br />` <br />ter John Acker 2019 <br />MAIL ADDRESS <br />Rainier <br />Everett <br />PHDN <br />98201 252-8487 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />Same <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICEN <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />C TY <br />ZIP <br />PHONE <br />LICEN <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICEII' <br />V ❑NEW (MODITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />f 600.00 <br />work shop <br />PROPOSED USE OF BUILDING <br />sin le • family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS, <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORREI <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING TF <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFI <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES N <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PF <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATII <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ,J9/24/79 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT 9_lQ 417 Capitol Hill <br />LocK_—oF <br />JOB ADDRESS <br />2019 Rainier <br />PLUMBING <br />MECHANICA <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 />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEACERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />SUB TOTAL f <br />PERMIT f <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL <br />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 />_ <br />LOT AREA <br />VACANT SITE <br />'I :YES ❑NO <br />F3E� <br />VALUATION <br />_ <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />b 600.00 <br />6 <br />C <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 />L)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 />3. FIRE HYDRANT <br />TOTAL , <br />6 <br />C <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />• <br />y <br />'1 O'U R REC EM <br />THANKYOU <br />I <br />. <br />5GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />