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F] <br />,reen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />�C�VSTRUCTI©C. <br />PERMIT PERMIT NO. 08551 <br />❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Earl Bray 252-8021 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />D S M Custom Homes <br />7042 Highland <br />Drive Clinton <br />221-7560 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE 1 <br />DS MC UH 2O6CH <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE 1 <br />❑NEW ❑ADDITION ❑ALTERATION kJgEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />$ 4850.00 <br />instal block foundation <br />PROPOSED USE OF BUILDING <br />single family residence <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 LAWS AND ORDINANCES GOVERNING 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 />CONSTRU ,:ON OR THE PERFORMANCE OF CONSTRUCTION. <br />SIG�yygT�URP ONTRACTOR OR AUTHOPI ED AGENT DATE_ <br />;� �����'� L� 11/10/80 <br />LEGAL DEECRIPTIONOFPROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />5LLq 1, 2 , L,, 72?DF Everett Div. H <br />JOB ADDRESS <br />3001 Nassau <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — N.P. EA <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS — H P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — BT.U. M EA, <br />DISHWASHER <br />WALL HEATERS — B.T.U. AI <br />LAUNDRY TRAY <br />UNIT HEATERS — B T.U. M <br />_ <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 — GEM. <br />VAC.'UN� BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />SUBTOTAL $ <br />_ <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />RrAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S 4850. <br />50 <br />50 <br />SIZE OF BI OG. <br />NO, OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />SEC. 3U BC <br />03 (a) <br />2. BUILDING PLANS <br />TOTAL <br />50 <br />— <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />- 019 9 $ 0 50.50 -- <br />Lr <br />LC <br />I 1 .J IY RECEIPT °C <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />S. HEALTH JISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />