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i <br />D <br />the ET'er <br />CITYPen OF �- ^,ONSTRUCTION <br />everett PERMIT PERMIT NO. 122 )Q <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 U COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY Zip PHONE <br />ELMER JOHNSTON 3424 ROCKEFELIER Everett WA 98201 259-3922 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE M <br />Owner <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE , <br />❑ NEW ❑ ADDITION ), ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />f 1,000.00 <br />Install dishwasher, sink,ranqe hood, cabinets/shelves, stairs, handrails, closet <br />PROPOSED USE OF BUILDING <br />Residence <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 PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR Fj CO TRUCTION. <br />SIGNATU RA OR 0 A HORIZED AGENT PATE <br />x- �'� 7 26 83 <br />LLGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />L012l 228LOCKB2.LDF FVPrPtt I' II <br />_ <br />JOB ADDRESS <br />PLUMBING <br />MEC ICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />YPE 29 EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR CONO 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 A.C. UNITS — TONNAGE EA. <br />1 <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA <br />1 <br />DISHWASHER <br />2 <br />WALL HEATERS — B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />1 <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE — WOOD <br />_ <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL <br />f <br />SUB TOTAL f <br />4 <br />5O <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FEE S1 <br />150 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />:7YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />q ,000.00 <br />17 <br />50 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />4 <br />— <br />00 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />. _YES .:]NO <br />MECHANICAL <br />4 <br />50 <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />Z6 <br />O <br />3. FIRE HYDRANT <br />FIRE SYST� <br />PERMIT <br />�N PROPE LY Vl1 LIDATED(IN THIS C )bTHISI Q� R I <br />�` � 3 b � U 1 7. L(7 <br />cmCV <br />L '--C p (1�.JV' <br />f <br />rnY��'•! R REC E I I,�l <br />p rn o {A,p.ir YOU <br />GRADINGTECTION <br />5. <br />6. DRAINAGE - <br />\LIMPACTSTATEMENT <br />ENVIRONME <br />p7. <br />HEALTH OS <br />r <br />TBY <br />APPLICATI74N LANS CHECKED BY <br />m <br />APPR. FOR ISSU-NCE BY <br />LC <br />IJ m — <br />cz I i6JULgJ <br />ADDRI:SS FRE <br />