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N <br />0 <br />the Evergreen CO N ST R U CT I O P' <br />CITY OF <br />everett PERMIT <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION <br />E BUILDING LJ MECHANICAL <br />PERMIT NO. 09951 <br />❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Irene Nielsen 2110 Rainier Everett 98201 259-5384 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Same <br />MECHANICAL CONIRACTOR MAIL ADDRESS CITY ZIP PHONE UCENSEI <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR El DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />S 125.00 <br />DESCRIBE WORK <br />install ramp for handicapped.person <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PI (CATION AND KNOW THE SAML TO gF TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES uOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CANTS TOR O THORIZED AGENT DATE <br />X•'^ 10/28/81 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />28 44 Capitol Hill <br />JOT BLOCK_1OF <br />JOB ADDRESS <br />2110 Rainier <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUMM <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS - H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS - H <br />LAVATORY (WASH BASIN) <br />BOILERS - N.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS - T <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS - B <br />DISHWASHER <br />WALL HEATERS-B.T.U. <br />LAUNDRY TRAY <br />UNIT HEATERS - B.T.U. <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 - RAINLEADERS <br />METAL FIREPLACE 3 CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />SUB TOTAL <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL <br />FEE $ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />I RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />[]YES aO <br />FEES <br />VALUATION <br />FEE — <br />TYPE OF CONST. <br />V-N Wood <br />OCCUPANCY GROUP <br />R-3 <br />NO. OF DWELLING UNITS <br />1 <br />BUILDING <br />S 125.00 <br />10 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />ramp <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REOUIR❑XEEDO�O <br />YES TLI <br />MECHANICAL <br />— <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENAL <br />U.BC. <br />SEC. 303(R) <br />- <br />2, BUILDING PLANS <br />---- <br />TOTAL <br />10100 <br />3. FIRE HYDRANT <br />- <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />1. <br />LC <br />CT <br />Q <br />C <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />HWM <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />