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the Evergreen ." C04STRUCTION <br />CITY OF PERMIT <br />everett PERMIT N0. 08055 <br />CITY HALL 259 8745 COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING <br />EVERETT. WA 98201 PHONE <br />MAIL ADDRESS <br />Cltt ZIP <br />OWNER 98203 355-151:. <br />Karl Klasman 5623 Rockefeller Everett ZIP PHONE <br />MAIL ADDRESS <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP PHONE LICENSE � <br />GENESAL CONTRACTOR <br />Same Cltt ZIP PHONE LICENSE <br />_ MAIL ADDRESS <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE LICENSE � <br />PLUMBING CONTRACTOR <br />CLASS OF WORK <br />❑NEW []ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN JkGARAGE <br />VALUATION OF WORK <br />$ 1900.00 <br />DESCRIBE WORK <br />carport <br />PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />single family residence PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />LEGAL DESCRIPTION OF PROPERTYISHOW BELOW OR ATTACH FOUR COPIES) ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />Laurel Hei hts TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />Lor 9 BLocK 8 OF 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 R AUTHORIZED AGENT <br />JOB ADDRESS X "�— _ `/ /" J✓ <br />5623 Rockefeller <br />MECHANICAL <br />PLUMBING TYPE OF EQUIPMENT FEE <br />NO. <br />NO. TYPE OF FIXTURE OR ITEM FEE AIR COND. UNITS — H.P. EA. <br />WATER CLOSET (TOILET1 REFRIGERATION UNITS — H.P. EA <br />BATHTUB BOILERS — H.P. EA. <br />LAVATORY (WASH BASIN GAS FIRED A.C. UNITS — TONNAGE EA. <br />SHOWER FORCED AIR SYSTEMS — B.T.U. M EA. <br />KITCHEN SINK 8 DISP. WALL HEATERS — B.T.U. M <br />�muwecuoR n.uT MFATFRS — B.T.U. M <br />-- PERMIT <br />' <br />- <br />TOTAL FEE <br />TOTAL FEE <br />SETBACK <br />f <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />RECEIPT NO <br />SIDE YARD SETBACK STREET <br />80/8055 <br />FEE 9 , 5 0 6-on g <br />6, <br />LOT AREA <br />VACANT IT <br />FEES <br />VALUATION FEE <br />USEZONE <br />OYES <br />R-1 <br />TYPE OF CONST. OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />S1900.00 19 0 0 <br />V-N <br />BUILDING <br />SIZE OF BLDG. NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />17'x221 1 <br />FIRE ZONE BASEMENT <br />FIRE SPRINKLERS <br />R <br />MECHANICAL <br />3 <br />ESIRED O <br />BY DATE <br />OTHER <br />APPROVALS <br />U.B.C. <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />19 00 <br />3. FIRE HYDRANT <br />PERMIT VALIDATION PERMIT <br />PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR <br />4. FIRE PROTECTION SYSTEM <br />WHEN <br />0 Q �? O (] -- <br />5. GRADING <br />6. DRAINAGE <br />C:) <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />YQ U R RECEIPT o <br />6. HEALTH DISTHIC7 <br />PLANS CHECKED BY <br />APPR, FOR ISSUANCE BY <br />J HANK YOU , <br />APPLICATION ACC. BY <br />V.C. <br />26Aw80" <br />ADDRESS FILE <br />