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the E"CTYOF CC-1STRUCTION <br />everett PERMIT PERMIT NO. 07591 <br />CITY HALL 259.8745 <br />EVERETT. WA 98201 ❑ COMBINATION IN BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS ulv ZIP PHONE <br />James Eccles 5408 South 2nd Avenue 98203 259-2712 <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PLUMBING I.ONTMCiOR MAIL ADDRESS <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION IX50REPAIR <br />VALUATION OF WORK <br />S 150.00 <br />DESCRIBE WORK <br />re -roof bathroom area <br />PROPOSED USE OF BUILDING <br />residential <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK 26 of Plat of Lowell <br />JOB ADDRESS <br />5408 South 2nd Avenue <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK ISFRVICF — RAR FTC I <br />SUB <br />CITY 21P PHONE LICENSE <br />CITY ZIP PHONE LICENSE 1 <br />CITY ZIP PHONE LICENSE <br />❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />I HEREBY 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 VIOI ATE OR CANCEL THE PRO. <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL H, ATERS — B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE <br />METAL FIREPLACE & CHIMNEY <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PIAV CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />N0. OF DWELLING UNITS <br />BUILDING <br />$ 150.00 <br />S <br />00 <br />SIZE OF BIOG <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REOUIRED <br />❑YES ONO <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 />2, BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />S <br />00 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />r--I <br />2 1 8 7 $ 0 05. 0 0 1` <br />CDYCFUR; PCIIFIT <br />%►*tAl1K ','bu <br />5 GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC=CHECKED <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE I <br />