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F <br />the Evergreen �f / <br />CITY OF O N ST R U CT I O N <br />everett PERMIT PERMIT NO. 11259 <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 D COMBINATION ❑ BUILDING D MECHANICAL . PLUMBING <br />OWNER MAIL ADDRESS CITY <br />H Jack Phillips 4424 South 3rd Everett 98201 259-3958 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE <br />Tom Lawrence <br />CITY <br />21P <br />PHONE UCENSEI <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />Snohomish <br />ZIP <br />98290 <br />PHONE LICENSE! <br />337-2114 <br />Charles Mueller 13616 48th Srive S.E. <br />Cuss OF WORK <br />❑NEW ❑ADDITION <br />DEMOLITION FENCE <br />❑ALTERATION ❑REPAIR ❑❑ <br />❑SIGN <br />Mak LP 20ORZ <br />L <br />s 440.00 <br />DESCRIBE WORK <br />M,.. .,,Il v wi 1-h roomer water Pipes <br />replace a4-4. yaiv au+.��.. �� <br />--•--- --- ----- <br />- - <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />LOT BLGCK--__GF <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 />SIGNAIUREAUTHORIZED AGEN LATE <br />OR <br />� 11I18I82 <br />JOB ADDRESS <br />4424 South 3rd Avenue <br />X - //�J <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />2 <br />OO <br />AIR COND. UNITS — H.P. EA <br />ER CLOSET (1011 <br />2 <br />OO <br />REFRIGERATION UNITS — H.P. EA <br />HTUB <br />BOILERS — H P. EA, <br />TORY (WASH BASINI <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />WER <br />2 <br />OO <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />HEN SINK 6 DISP. <br />WALL HEATERS — B T.U. M <br />WASHER <br />UNIT HEATERS — B T.U. M <br />NDRY TRAY <br />ISINK(SEM <br />2 <br />00 <br />EVAPORATIVE COOLERS <br />THES WASHER <br />2 <br />OO <br />CLOTHES DRYERS <br />ER HEATER <br />VENTILATION FAN <br />NAL <br />RANGE HOOD <br />NKING FOUNTAIN <br />AIR HANDLING UNIT — C F.M. <br />OR DRAIN <br />UUM BREAKERS <br />STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />F DRAINS — RAINLEADERS <br />K (SERVICE —BAR. ETC) <br />SUBTOTAL <br />f <br />SUB TOTAL <br />PERMIT <br />f <br />PE7kMIT <br />f <br />TOTAL <br />FEE f <br />TOTAL FEE <br />SIDE YARD SETBACK STREET SETBACK <br />f 1 q n n <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑YES ❑NO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF SLOG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />15 <br />OO <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE REQUIRED SPRINKLERS <br />MECHANICAL <br />I IYES IIND <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />I. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />SEC. 303 (e) <br />2. BUILDING PLANS <br />1S <br />OO <br />TOTAL <br />3, FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPOCT 11T IS "$,OP T5' 0 O <br />1 i ? V <br />' • I <br />5. GRADING <br />6. DRAINAGE <br />FT � <br />YOU " R LC E I PT <br />HANK F. .^ <br />) 7, 1 A � K Y V U e <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8, HEALTH DISTRICT <br />APPLICATION ACC, BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />