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CITY OF N � �- <br /> everett PERMIT pERMIT N0. OSH74 <br /> CITV HALL 259�B7d5 � <br /> EVERETT,WA 9g201 ❑ COMBINATION ❑ BUILDING C�MECHANICAL ❑ PLUMBING , <br /> OWNER MAILPODNE55 C.Y ZIP PHONE � <br /> Ted Westrom 1115 Pacific Everett 98201 252-1546 <br /> AACMITECT Oq DESIGNER MFIL ADDHESS pTY <br /> Z�P MIONE <br /> G[NENALCONTRACiOq MAILApDPE55 pTY <br /> $dIGE 2�P MONE LiCENSE 1 <br /> M[CMAN:C.L fqNTRACTpq MRIL ADDFE55 piT zlP PHONC LICENSE I <br /> PLUMBING ANTNAGTOq MAII AODflESS GiY <br /> z�P PHONE UCENSE I <br /> ClASE OF WOR1( <br /> ❑NEW ❑FDDITION ❑AITEFATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> VAWAiION Oi WORK <br /> f <br /> DESCRIBE WOqK <br /> inetall wood stove <br /> PAO�'OSED USE OF BVRDING <br /> I HEREBY CERTIFY THAT I HAVE READ A��D EXAMINED THIS AP- <br /> �eca�oescairrionoFrao�arvisHoweeiowoaenncHvouacoaies� PLICATION AND KNOW THE SAME TO '3E TAUE AND CARRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THI: <br /> �o� d�°°K_oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIIJ OR NOT. THE GRANTING OF A PERMI7 DC'cS NOT <br /> FRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCFL THE PRO- <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CO�CTION�THE PERFORMANCE OF CONSTRUCTION. <br /> _K%P,RDDRE55 SIGN 4UR ��pNTqA OR AULNONIZCO FGENi DAT[ <br /> 1115 Pacific Ave. X ' �/+� ��-r,�� 2/11/81 <br /> PLUMSIN6 MECMANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATEp CLOSET(TOILET) AIR('qND. UNITS—H P FA <br /> BATHTUB REFRIGLRATIOIJ UNITS—N.P.EA <br /> V�VATORY(WASH BASIN) BOILERS--HP.EA. <br /> SHpWER GAS FIRED A C UNITS—TONNA,E EA. � <br /> NITCHEN SINK d DISP. FORCED AIR SYST[MS--�'.U. M EA. <br /> DISNWASHER WALL HLATERS—AIL. M <br /> LAUNDRY TRAV UNIT NEAIERS--B T.U. M <br /> CIOTHES WASHFR [VA4'ORATIV[COOlEFS <br /> WATER HEATER C�OTHES DRYERS <br /> URINAL VENTII.AiION FAN <br /> DRINKING FOUNTAIN RANGE HppD <br /> FLCOR DRAIN AIR HANDLING UNIT— <br /> CFM <br /> VACUUM BREAKEFS STOVG <br /> NOOF DRAINS—RAINLEADEPS METAL f IREPLACE B CH!MNEV <br /> $INK(SERVICE—BAR.RC.) <br /> SUL TOTIIL SUS TOTAL f 9 S 0 <br /> . PEIIMIT f PERMIT f 00 <br /> TOTAL FEE f TOiAI FEE f 7 S O <br /> SIDE YARD SETBACN STREET SETBACK qEAR YARU SETBACN PLAN CHLCK NUMDER PLt.N CHECN FEE <br /> F[E R[CEIPT NO. <br /> USE ZONE LOT AREA VAGANT SIT[ <br /> I:VES C7N0 FEES VALU�TION FEE <br /> TYPE OF CONST. OCCUPANCV GROUP NO.Of DWELLING UNITS <br /> BUILDING y <br /> SIZE OF BLDG NO.OF STORI[S MA%.OCC.LOAD <br /> PLUMBING <br /> FIPE ZONE BASEMENT FlRE SPRINKLERS <br /> REOUIRED MECHANICAL � S O <br /> f;vES 1'NO <br /> APPROVAIS BV DATE OTHER <br /> L [NVIRONIIENTAL CHECK LIST <br /> __� PENALTV U.BC. <br /> 2. BUILDING F'ANS SEC.3031a1 <br /> 3. RRE HYDRANf TOTAL 7 S 0 <br /> 4. FIRE PROTECTION SVSTEM GERMIT VALIDATION <br /> 5. GRADRJG WHEN PROPERLV VALIDATED(IN TNIS 5:'ACE)THIS IS VOUR PERMIT <br /> G DHAINAGE V� <br /> 7. ENVIRONMCNTAL IMPACT STATEMENT 'i ' - l C �1 .� 7 I; ,� __� <br /> 0 H[ALTH DISTFICT V ! •••V.{ <br /> — � <br /> APPurATION ACC BY PLANS CHECK[D BY APPR.FOR ISSUANCE BY � <br /> _ � . . <br /> N.C. . � , � <br /> � � <br /> l,CDRESS FILE <br /> �- <br />