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. � <br /> 1 <br /> 7heLti'ergreen ^ONS�RUCTIOI� � <br /> GTY O'r � � <br /> everett PERMIT PEAMir No. 11469 <br /> CITV HALL 259�37-05 <br /> eveaerr.wn sezo� ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING <br /> 0\VN[N M41L 4UDR65S Gil' ZIP PMONf � <br /> James Rhodes 2928 Maple Everett 96201 <br /> APCNIiECT CR OESIGNCR R!AIL ADDRE55 CITY 21P PMONE <br /> GENEqALCON'RACTOR MAILApDRE55 CRY ZIP PHONE LIGENSE� <br /> MECMAHICAL CONTRACiCR Mf+IL ADDRE55 CIiV ZIP P110NE UCENSE I <br /> Natural Gas Equipment 1611 �ast Marine View Drive 98201 258-2441 , <br /> PLUMBINGCONiPAGTOR AIAILADpRESS QiY ZIP PNONE liCkNSE� <br /> ClAS50F WORN <br /> ❑NEW ❑ADDITION ❑ALTERA?ION ❑REPAIR ❑OEldOLIT10N ❑FENCE ❑SIGN ❑GARAGE <br /> VALUATION OF WORN <br /> 5 <br /> �ESCRI�E WOPK <br /> PROPOSEO USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> ucnioesca�rnorvovvROFEatvisHowoeiowonnrrncNreuncorics PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS ANJ ORDINANCES GOVERNING THIS <br /> ior e�oc�_or TYPE OF WORK WILL BE COMPLIED WITH WHETI-IER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMI'i DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCE�THE PRO� <br /> � VISIONS OF ANY OTHER STATE OR LOCAL LAW REC.ULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIG^iAtURE OF CONt A iOR 0(i A NOR12E0 AGENi DFTE <br /> JO[iAD�RE55 <br /> 2928 Maple � X � � 1/28/83 <br /> PLUMBING MECHANICAL �, <br /> NO. TYPE OF FIXTURE OF ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATEP LlOSET 110RET� AIR CON[7. UNIiS—NP.EA <br /> BATNTUB REFRIGGRATION UNITS—hl B EA <br /> LAVFTORY(WASH BASIN) �OILEPS--HP.EA. <br /> SHO\VER GAS FlRED AC.UNIiS—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORC[D AIR SYSiEMS—8 TL. M EF. _ <br /> �ISHWASHER IYALL MF.AiERS—BT.U. M <br /> LAUNORY TFAV UNIT HEATERS—8 T.0 M <br /> CLOTH[5\YASHEN EVAPORATIVL COOLERS <br /> WAi�p�{�qTEq CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HO00 <br /> FLOOR ORAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKEPS SiOVE <br /> ROOF DRAINS—RAINLEA�ERS MC:TAL FIR[PWCE 8 CHIMNEV <br /> SINK�SEHVICE—�AR.ETC) <br /> SUB TOTAL SUB TOTAL 5 2 0 U <br /> PERMIT S PERMIT S <br /> TO7AL FEE S iOTALFEE S <br /> SIDE�ARD SETBACR STREET SETdACK REAR YARD SETBACK Pi AN CHECK NUM�EF7 PLAN CHECK FEE <br /> (E@ RECEIPT NO. <br /> USL ZONE LOT AREA VACANT SITE <br /> I!YES �_INO FEES VAIUAT10N FEE <br /> TYPE OF CONST. OCGUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING $ <br /> SIZ[OF BLDG. NO.OF STORIES MA%.OCC.LOAD <br /> PLUMBING <br /> F'IREZONE BASEMEtlT FIRESPPINKLERS <br /> REOUIRED IdECHANICAL LZ OO <br /> � ! IYES I�NO � <br /> �— APPHOVALS BY DATE OTHER <br /> 1. ENVIRONMENTAL CHECK LIST pENALTY U BC <br /> SEC.3031a� _ <br /> p. UUILDING PLANS <br /> TOTAL 12 00 <br /> 3. FIRE HVDRANT <br /> 4. FIRE PR�iEC710N SVSTEM PEHMIT VALIDATION <br /> WHEIJ PROPERLY VALI�ATED(IN THIS SPACE)TH1515 YOUR PERMIT <br /> 5. GRADIhG [ S Q 6 E O I L. O O � � J <br /> 6 DRAINAGE <br /> 7. ENVIRONMENTAL Il.1PACT STATEMENT ' � <br /> — �' / �—� <br /> B. H[ALTHDISTRICT 'lO'U�R RECEIPT "� <br /> APPLICATION ACC.BY PLANS CHECKEU B! APPR.FOR ISSUANCE BY • � �� � <br /> T� ;n,r3K YUU <br /> 1 8 �� 8 3 <br /> ADDRESS FIL[ � <br />