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1he Ecertrpen <br /> �����F �'`, r~�;ONSTRUCTIOh'� r"� <br /> everett PERMIT PEaMir No. 16416 <br /> CITY HALL 259�8745 <br /> EVERETT.VJn 98207 � COMBINATION � BUILDING .� MECHANICAL ❑ PLUMBING <br /> OWYER MAILADDRESu CITY 21P PNONE <br /> Robert Jungaro P.O. Box 363 Mukilteo, WA 98275 355-4196 <br /> ARGNITEGT OR DESIGNER M41L ADDRE55 dTY 21P PMONE <br /> GENERAL pONTR�GIOR MAIL ADDRESS CITY ZIP PMONE LICENSE• <br /> Self <br /> MEGNANICOLCONTRAf.TOF MAILADDRESS GiY ZIP PNONE UGENSE• <br /> rIUMBING CONTRACTOR MAIL ADORE55 LITY ZIP PHONE LILENSE I <br /> CU55 OF WORK <br /> ❑NEW ❑ ADDITION ❑ ALTERATION ❑REPAIR � DEMOLITION ❑ FENCE O SIGN O WOOD STOVE/FIREPLACE INSEFi7 <br /> VALl1ATI0h Of WORK <br /> s <br /> DESCRIBE WORN <br /> Demolition <br /> PROPOSED USE OF BUILDING <br /> Single family residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAL DESGRICTION OF PROPERTY�SMOW BELOW OP RTTACH FOUR COPIES) CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �or 1 e�ocK �3Z oF Everett Div H GOVERNING THIS TYPE OF WORK WILL BE COMPUED 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 STPTE OR <br /> LOCAL L REGULATING CONSTRUCTION OR THE <br /> PERFOR CE 0� CONSTRUCTION. <br /> JOB ADDRESS vGNATUR 0 �TRnC OR OR RUTHORIZEO�GENT DRTE <br /> 1110 Pacif c ^ aiLiA� <br /> , ►LUMlIN6 MECHANICAL <br /> NO. TYPE OF FIKTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATEHCLOSET�701LET1 AIR COND. UNITS — H.P.EA. <br /> BATMTUB REFRIGEtiATION UNITS— H.P. EA. <br /> LAVAiORV(WASHBASIN) BOILEFS — H.P. EA. <br /> SMOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK d DISP. FORCED AIR SYSTEMS— B.T.U. M EA. <br /> DISHWASMER WALL MEATERS— B.7.U. M <br /> LAUNDRV TRAY UNIT HEATERS — B.T.U. M <br /> CLOTHES WASHER EVAPORRTIVE COOLERS <br /> � W�TER MEATER CLOTHES DRVERS <br /> � URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOON DHAIN AIR HANDLING UNIT— f,.F.M. <br /> VACUUM BREAKERS STOVE —WOOD <br /> ROOF DRAINS— FAINLEADERS METAL FIREPL4CE 8 CHIMNEY <br /> SINK�SERVICE — BAF.ETC.) FIREPLACEINSERT <br /> HEAT PUMP <br /> SU!TOTAL t SU!TOTAL T <br /> , PERMIT f PERMIT f <br /> TOTAL FEE f TOTAL FEE t <br /> $IDE YARD SET9ACK STREET SETBACK FEAR VARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIP7 NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> YES NO <br /> TVPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING E —O— <br /> SIZE OF BLDG. NO.OF STORIES MA%.OCQ LOAD <br /> PLUMBING <br /> FIREZONE BASEMENT FIRE SPRINHLERS M'cGHANICAL <br /> REOUIRED <br /> YES NO <br /> AP7ROVALS BY DATE �THER <br /> t ENVIRONMENTAL GHECK LIST PENALTY U.B C. <br /> SEC.303(a) <br /> 2.BUILDING PLANS TOTAL —O— <br /> 3,FIRE HYDRANT <br /> 4.FIRE PROTECTION SVSTEM GERMIT VALIO�TION <br /> 5.GRADING WHEN PROPERLY VALIDATEO(IN THI�S�4�F)THIS FS rO�If�PFq:N1T _ ti,.' <br /> 7 lU <br /> 6.DR�INAGE Renewal of permit #11931, issued 1/21/83 <br /> 7.ENVIRONMENTALIMPACTSLATEMEN7 � . , <br /> B.HEIILTH DISTHICT � ' � ' � . <br /> �PPLIC�TtON ACC.BY PLANS CHECKED BY APPR.FORISSUANCF BY ' ' <br /> L.C. L.C. <br /> ADDRESS FILE <br />