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ME, Evergreen <br />CITY OF <br />everett <br />CITY HALL 259.87A5 <br />EVERETT. WA 98201 <br />CONSTRICTION <br />PERMIT <br />❑ COMBINATION 91 BUILDING L_1 MECHANICAL <br />• <br />PERMIT NO. 06586 <br />LJ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Francis E. Jacobs 3507 Rockefeller 98201 252-7346 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PL JMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION $iCiEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />$ 500.00 <br />ci F 1 f1T YP-YllllA <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />single family residence <br />CT. <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.T. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GCVERNING THIS <br />PROPERTY BELOW OR ATTACH FOUR PIESI <br />LEGAL DESCRIPTION OF RCO <br />D855 Everett <br />Div. M <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />LOT BLOCK__OF <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 />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />CIGN URE 0' OONIRACTON OR U-:IORIZED A NT DATE <br />8/23/79 <br />JCB ADORe�S <br />507 Rockefeller <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 - HP..EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS - H P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />SHOWER <br />KITCHEN SINK & DISP. Everett Div <br />FORCED AIR SYSTEMS - 8 T.U. M EA, <br />DISHWASHER <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 />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />SUBTOTAL S <br />5 <br />00 <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL <br />FEE f <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 />ESITE <br />OVAS TONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />f <br />5 <br />OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />DASEMENT <br />FIRE <br />REQUIRED <br />SPRINKLERS <br />MECHANICAL <br />OYES <br />ONO <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 />5 <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 />L� <br />emou <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />f] p /•� p�C0 <br />R E I <br />YOUR <br />Ff O <br />8. HEALTH DISTRICT <br />U REC f f CD <br />THANK Y O U <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />�Z3aul; 19 <br />ADDRESS FILE T <br />