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0 <br />B <br />rhn Evergreen CITN OF <br />C O N ST R U CT I O" <br />everett PERMIT PERMIT NO. 12163 <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION ki BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />A. L. ARMSTRONG,/CHARLES GILKEY PO Box 899 Everett WA 98206 259-6043 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE A <br />Same <br />MECHANICAL CONTRACTOR <br />MAIL ADDRES!. <br />CITY ;iP PHONE <br />LICENSE <br />PLUMBING CONTRACTOR MAII ADDRESS Clio 21P PHONE LICENSE A <br />11—v --D NEW ❑ ADDIT ON ❑ ALTERATION i❑ REPAIR XM DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />S <br />n.P,i 4 c h nananu and mall nff,*CP <br />PROPOSED USE OF BUILDINGy <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGU TINE CONSTRUCTION OR THE <br />PERFORMANCE OF STRUCTION. <br />SIGNATURE ONTRA A AG:NT �/5/D14?E <br />X _ 83 <br />LEGAL DESCRIPTION OF P90PERTY(SNOW BELOW OR ATTACH FOUR COPIES) <br />13,14 15 610 Everett <br />LOT _9LOCK_OF <br />JOB ADDRESS <br />2631 Rockefeller <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO.M <br />YPF: OF EOUI ENT <br />FEE <br />WATER CLOSET(TOILET) <br />NITS — H.P. EA.BATHTUB <br />ION UNITS — H.P, EA.LAVATORY(WASH <br />BASIN) <br />H.P. EA.SHOWER <br />.C. UNITS — TONNAGE EA.KITCHEN <br />SINK& DISP. <br />SYSTEMS — B.T.U. M EA.DISHWASHER <br />RS — B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.IJ. M <br />CLOTHESWASHER <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 — C.F.M. <br />VACUUM BREAKERS <br />STOVE — WOOD <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPI.AGE INSERT <br />HEAT PUMP <br />SUBTOTAL <br />S <br />SUB TOTAL S <br />RM <br />PEIT <br />S <br />PERMIT $ <br />TOTALFEE <br />f <br />TOTAL FEE $ <br />SIDE YARD SETBACK <br />STREEI SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />HECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />-.YES LjNO <br />FEES <br />VALU ATION <br />FEE <br />_ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />00 <br />OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES NO <br />MECHANICAL <br />—_ <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PLIIALTY <br />U.B.C. <br />SEC..303 (ai <br />2. BUILDING PLANS <br />TOTAL <br />0 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PnOTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IN THIS OSP2 1 TMI I^q YQUji•P�fjMIT (1'] <br />0 7[ fUl U o U l�Wl <br />pp (V <br />YOUR RI=CEI1p T <br />THANK YOU <br />_ <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DI STRICT <br />APPLICATIUN ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />-i 1 <br />ADDRESS FILE <br />-LSL83 <br />