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'"e``��;�e�F r� � CONSTRUCTIG�I � <br /> everett PERMI� PERMIT N0. 15q5H <br /> CITY HALL 259�8745 <br /> EVERETT,WA 98201 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING <br /> OWNER MAIL ADDPESS CITY ZIP PHONE <br /> John F. Staudt 2105 Madison Everett 98203 <br /> ARCMITF.CT ON UESIGNEH MRIL AD�RESS CITY ZIP PMONE <br /> GENERFL GONTRACTOfl <br /> MAIL AOORESS CITY ZIP PHON: LICENSE� <br /> MEGHANICALCONTFACiOR <br /> - MAIL A�ORESS CITY ZIP PMONE LICENSE I <br /> PLUM31NG CONTRAGTOR <br /> MAIL AOORESS CITY ZIP PHONE LICENSE� <br /> $dIRO <br /> CLA55 OF WORK <br /> ❑ryEW ❑ ADDITION ❑ ALTERATION ❑REPAIR O DEMOLITION � FENCE ❑ SIGN O Wn00 STOVFIFIREPLACE INSER <br /> VALUATION OF WORN <br /> S <br /> DESLRIBE WORK <br /> PROPOSED lISE OF Bl11LDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAL OESCRIPTION OF PROPERTY�SHC'N OELOW OR ATTACM FOI1R COPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVERNING THIS TYPE OF WORK WILL BE COMPLIEG WITH <br /> LOT_�LOCK__OF WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERMIT DOES NOT PRESUHiE TO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF C NSTRUCTION. <br /> JOB ADUflESS SIGNATU dOF � CT AUT Rl EO AGENT OATE <br /> /� �j� 1/17/86 <br /> 2105 Monroe X�rJ✓ N ���'/' ' <br /> PLUMBING MGCHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EUUIPMENT <br /> FEE <br /> WATERCLOSET(TOILEn <IR COND. UNITS— H.P. EA. <br /> BATHTUB 2 QQ REFRIGERATION UNITS — H.P.EA. <br /> LAVA70RY1WASH BASINI O BOILERS— H.P. EA. <br /> SHOWEft <br /> GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYS7EMS— B.T.U. M EA. <br /> DISHWASHER WALL HEATERS— B.T.U. �'1 <br /> LAUNDRY TRAY UNIT HEATERS— B.T.U. M <br /> CLO7HES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DR;NKING FOUNTAIN RAN�E HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE —WOOD <br /> Fi00F DRAINS— RAINLEADERS METAL FIREPLACE 8 CHIMNEY <br /> SINK�SERVICE— BAR,ETC.) FIREPLACEINSERT <br /> HEAi PUMP <br /> SUB TOTAL t SUB TOTAL f _ <br /> PENMIT S PENMIT f _ <br /> TOTAL FEE S 1� � TOTAL FEE s L� <br /> P�AN CHECK FEE <br /> SIDE YARD SE7BACK STREET SE7BAG:' RE�R YARD SETBACK PLAN CHECK NUMBER FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> :7YES :..NO <br /> TYPE OF CONS7. OCGUPANGY GROUP NO.OF DINELLING UNITS <br /> BUILDING 5 <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC. LOAD <br /> PLUMBING 13 00 <br /> FIRE ZONE BASEMENT RIEOl1SRED KLERS MECHANICAL <br /> .�.YES ::�.NO <br /> BY DATE OTHEF <br /> APPROVALS U.B.C. <br /> 7.ENVIRONMEN7AL CHECK LIS7 PENALTY SEC.�OJ(a) <br /> 2.BUILDINGPLANS 13 00 <br /> TOTAL <br /> 3.FIRE HYDRANT <br /> A.FIRE PROTECTION SYSTEM PEHMIT VALIDATION <br /> WHEN PROPERLV VALIDATED pN THI�S$P��1 THIS�S�YQU�P�R�11T � <br /> 5.GRADING � �� � � <br /> 6.DRAINAGE � <br /> i.ENVIRONMENTALIMPACTSTATEMENT r � <br /> 8.HEALTH DISTRICT , � ^ � . .��I I�T � <br /> �i� �.`' .' r. I.i:(� <br /> APPLICATION ACC.BY PLANS CHEI:KED BY APPR.FOR�SSUANCE BY <br /> { I , tP�i� YL � <br /> I � , � r <br /> I � o <br /> ADDRESS FILE <br />