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�' l <br />� <br />� <br />�� � <br />�i _ <br />rhe£vergreen r^ CQ�`ISTRUCTION �^ <br />CITV OF <br />everett PERMIT PERMIT NO.O�56O <br />CITV HALL 259�0745 <br />EVERETT. WA 9B2C1 ❑ COMBINATION � BUILDiNG ❑ MECHANICAL ❑ PLUMBINO <br />OWNER MAIL AODPESS Cltt ZIP PHONE <br />Robert E. Blem 6815 Morqan Road 98203 353-6803 <br />APCHREGT OR OCSIGNER MAIL R�DRES`u CITV ZIP PHONE <br />GENERAI. fANTRACTOR MAIL q00RE55 LITY 21P PHONE LICENSE I <br />Same <br />IAECHANICAL CONTRAC70R MAIL AD�RESS CITY ZIP %10N4 LICENSE I <br />PLUMBINGCANTHnfTOR MFILADDNESS pTv IIp PMONE LICENSE/ � <br />C1A55 JF WORK <br />❑NEW g�{ ADDITION ❑ALTERA710N ❑REPAIR ❑DEMOLITION OFENCE ❑SIGN ❑GARAGE ' <br />VALUATION OF WORN <br />s 600.00 <br />'sinqle family residence <br />EGAL DESCRIPTION OF PROPERiY (SNOW BELOW OH ATTALH FOUP <br />�o, 11 di�„_�F Beverly Hills <br />S 12' of W 62' Lot 9 <br />JOB ADDPESS <br />�rqan Road 6815 <br />PLUMSINO <br />NO. TYPE OF FI <br />WATER CLOSEt (TOILETI <br />BATMTUB <br />LAVATORY M'ASH BASIN) <br />SHOWER <br />KIiCHEN SINN 8 DI:P. <br />SIDE YAFD SETBACK <br />7YPE OF CANST. <br />�nin�cnvcna <br />— BA�.ETC.) <br />SUlTOTAL <br />PENMIT <br />TOTALFEE <br />STREETSETBACK <br />LOT AREA <br />OCCUPANCY GROUP <br />1. ENVIRONMENTALCNECKLIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DFAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />A^PLICATION ACC. BY PLANS CHECKED BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF IAWS ArJD ORDINANCES GOVERNING THIS <br />iYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />FHESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE PRO• <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUg�OF GONTR LIOR OR AUTHORIZ/ED� GEN OATE <br />X ' ��l'��'�l � U'�`� � si�/An <br />MECXANICAL <br />FEE N0. TYPE OF EUUIPMENT FI <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERAiION UNITS — H.P. EA <br />�OILERS — H.P. EA. <br />GA$ PIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYS7EM5 — B T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATWECOOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — GF.M. <br />STOVE <br />METAL FIR[PU10E 8 CHIMNEV <br />SUBTOTAL f <br />PENM�T t <br />TOTALFEE <br />YARD SETBACK PLAN CHECK NUMBER PLAN CHECK PEE <br />FEE � RECEIPT NO. <br />VACANT SIiF <br />❑VES ❑NO <br />APPR. FOR ISSUA�JCE BV <br />L.C. <br />VALUATION <br />S 600.00 <br />U.B.C. <br />SEC.303 <br />TOTAL <br />� �� <br />� �� <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS V UR P RMI7 <br />ia�9 �0�6.00 -�,1 � <br />� � . <br />� <br />vouF R�cEi� <br />;�nNK You ; <br />ADDRESS FILE <br />, � .- ,] Wl' $ Q <br />� <br />r..� <br />