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the £TPITYeOOF COMSTRUCTION <br />everett PERMIT <br />CITY HALL 259 8, 75 <br />EVERETT. WA 98201 ❑ COMBINATION BUILDING ❑ MECHANICAL <br />PERMIT NO. 07664 <br />❑ PLUMBING <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />Orlo Fuller <br />6702 - 220th <br />SW Mountlake <br />Terrace 98043 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />BR-OC-KC <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP A LICENSE F <br />Randall S. Brockway <br />9510 - 232nd SW <br />Edmonds <br />98020 546-1858 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE F <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PRONE LICENSE IF <br />— V ❑NEW ❑ADDITION ❑ALTERATION aREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />. 800.00 <br />DESCRIBE WORK <br />Re air & re lace ' ists skirtincr shinales <br />PROPOSED USE OF BJILDING <br />Duplex rental <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 NO' <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSION OR THE PERFORMANCE OF CONSTRUCTION, <br />SIG URE CONTRA OR OR AUTNO ENT DATE <br />/ t <br />LEGAL DESCRIPTION OFPROPERTY ISHOWBELOW ORATTACH FOURCOPIES) <br />15&1�OA8S Rlat Of Everett Div "P" <br />LOT o <br />JOB ADDRESS <br />PLUMBING <br />HANICAL I <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 — H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS — TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FLACED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />MALL HEATLRS —BT.LL M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION Ft N <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLINL'JNIT — CF.M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />SUB TOTAL f <br />PERMIT <br />i <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL <br />FEE It <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR 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 />$ 800.00 <br />8 <br />00 <br />SIZE OF BLDG, <br />N0. OF STORIL3 <br />MAX. DOC. LOAD <br />PLUMBING <br />FIRE ZONE <br />DASEMENT <br />FIRE REQUIRED <br />EQUIRED <br />❑YES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />i. ENVIRONMENTAL CHECKLIST <br />PENALTI <br />U B C. <br />SEC, 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />8 <br />00 <br />3, FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />i 8 48 $ U O 9. O O -to <br />ti <br />FF�� p <br />YOUR CV EC E I R <br />THANK YOU <br />_ F <br />5. GRADING <br />6. DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />