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roe Evergreen <br />evereCITY CF tt r ".ONSTRUCTION <br />PERMIT PERMIT NO. 12878 <br />CITY HALL 2598745 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING U MECHANICAL ❑ PLUM9ING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />DAN CRISTOFFERSON MARYSVILLE 659-5458 <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 A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP ^NONE LICENSE <br />f <br />❑ NEW ❑ ADDITION U ALTERATION Cl REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN (I WOOD GTOVEIFIREPLACE INSERT <br />stove <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 JTHER STATE OR <br />LOCAL LAW REGULATNG CONSTRJCTION OR THE <br />PERFORMANCE OF CO RUCTION. <br />SIGNATURE OF CO TR TOR O A HO ED AGENT DATE <br />X 1/6/84 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK -OF <br />JOB ADDRESS <br />4906 S 2nd Ave <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 — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — I' 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 />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 />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />0o s Ove <br />SUB TOTAL <br />i <br />SUB TOTAL f <br />PERMIT <br />$ <br />L <br />PERMIT f <br />TOTAL FEE <br />$ <br />i TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEL <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />YES NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG, <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE -rA�� <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />I .YES NO <br />MECHANICAL <br />17 <br />50 <br />OTHER <br />APPROVALS <br />BY <br />GATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />17150 <br />3. FIRE HYDRANT <br />4. =IRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Ou <br />6 2 8 0 6 0 17. C O rA <br />00 <br />J R RECEIPT <br />N Y 0 u <br />5. GRADING <br />6. DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />E. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />D <br />ADDRESS FILE — 9 JUI 84 <br />