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The Er TOF CITY OF CC"VSTRUCTIO N <br />CI <br />everett PERMIT PERMIT NO. 08055 <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MLR ADDRESS CITY ZIP PHONE. <br />Karl Klasman 5623 Rockefeller Everett 98203 355-1512 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/ <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN GARAGE <br />VALUATION OF WORK <br />5 1900.00 <br />carport <br />PROPOSPO USE OF BUILDING <br />single family residence <br />I HEREE / 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 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X T16 5b­ <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH F 3UR COPIES) <br />9 8 Laurel Heights <br />LOT BLOCK_OF <br />JOB ADDRESS <br />5623 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 OIL <br />AIR COND. UNITS —H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY ASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.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 />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <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 8 CHIMNEY <br />SINK (SERVICE — BAR. ETC. <br />SUBTOTAL <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />61 <br />STREET SETBACK: <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />80/8055 <br />PLAN CHECK <br />FEE 9.50 <br />FEE <br />RECEIPT NO. <br />J"�ZJ O <br />USE ZONE <br />R-1 <br />LOT AREA <br />VACANT g�T� <br />OYES C <br />FEES <br />VALUATION <br />FEE _ <br />TYPE OF OONST. <br />V-N <br />OIA:UPANCY GROUP <br />M-1 <br />NO. OF DWELLING UNITS <br />1 <br />BUILDING <br />$1900.00 <br />19 <br />00 <br />SIZE OF BLDG, <br />17 T X22 1 <br />NO. OF STORIES <br />], <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />3 <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES VliMO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />100 <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />19 <br />4. FIRE PI;OTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 8 9 8 $ 019.0 0 '- ul <br />CD <br />U R REC E l f'T 000 <br />i HANK YO U <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONK;�NTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />V. C. <br />APPR. FOR ISSUANCE BY <br />