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" CONSTRUCTIC I <br />everett PERMIT PERMIT NO. <br />CITY HALL 25987:5 <br />EVERETT• WA 98201 COMBINATION ❑ BUILDING C MECHANICAL PLUMBING <br />PHONE <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />Donna E Wirt 4712 South 7rd <br />R FvPr�it 11Q �F� fiQ�� <br />ARCHRECT OR DESIGNE <br />MAIL ADDRESS CITY ZIP PHONE <br />UCENSEI <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY 21P PHONE <br />AT_L.. F'396 SR99 Lake Stpvpnq WA 9R95R fDl rn71 AIDHAC?9UH <br />NSE I <br />PLUMBING CONTRACTOR MAIL AGGRESS CITY ZIP PHONE LICE <br />CLASS OF WORK <br />❑ NEW ❑ADDITION ❑ ALTERATION BY.REPAIR ❑DEMOLITION ❑ FENCE ❑SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />m <br />CHIP "ehab <br />PROPOSED USE OF BUILDING <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Residence <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />DESCRIPTION OF PROPERTY ISHOIY BELOW OR ATTACH FOUR COPIES) <br />LEGAL <br />GA" <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />2 Lowell Div. <br />L <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANT ING OF A <br />__BLocK_._oF <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TC VIOLATE <br />OR CANCEL NLOCAL LAW HREGULLAITIOGS OFNSTR CANYTTION HER OR <br />THE <br />PERFORMANCE OF CONST CTION. <br />SICNA F CONTR OR AUT 0 IZED AGENT ATE <br />X 7 2D 84 <br />JOB ADDRESS <br />4712 South 3rd <br />MECHANICAL <br />PLUMBING <br />FEE <br />N0. TYPE Of EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />AIR COND. UNITS — H.P. EA. <br />WATER CLOSET(TOILET) Q <br />REFRIGERATION UNITS — M.P. EA. <br />BATHTUB <br />Inn <br />BOILERS — M.P. EA. <br />LAVATORY (WASH BASIN) <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />SHOWER <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />KITCHENSINK 6 DISP. <br />WALL HEATERS —B.T.U. M <br />D DISSHWASHHWASHER <br />UNIT HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE MOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT — C.F.M. <br />FLOOR DRAIN <br />STOVE FI WOOD <br />VACUUM BREAKERS <br />METAL FIREPLACE 8 CHIMNEY <br />ROOF DRAINS — RAINLEADER$ <br />R <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL <br />i 14 <br />DD <br />SUB TOTAL : <br />S <br />PERMIT = <br />PERMIT <br />S 14 OO <br />TOTAL FEE s <br />TOTAL FEE <br />SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK <br />PLAN CHECK PLAN CHECK FEE <br />REC PT 0. <br />•NUMYB'E� FEE Z�� <br />0 U( �` o <br />USE ZONE <br />LOT AREA VACANT <br />SITE <br />FEES <br />VALUATION <br />FEE <br />YES -NO <br />TYPE OF CONST. <br />OCCUPANCY GROUP NO. <br />OF DWELLING UNITS <br />BUILDING <br />S 18,600,00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />1 <br />FIRE ZONE BASEMENT <br />FIRE SPRINKLERS MECHAN CAL <br />REQUIRED <br />'-YES <br />LNO <br />APPROVALS <br />BY DATE OTHER <br />U.B.C. <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY SEC. 303 (a) <br />EEa <br />2. BUILDING PLANS <br />TOTAL <br />3. FIRE HYDRANT r- <br />A. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR''11 PERMIT („C <br />13 <br />LC <br />r <br />,. li 1 T <br />_ <br />S. GRADING <br />B. DRAINAGE cif <br />7, FNVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH IS ICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />0 <br />D <br />W <br />ADDRFS5 FII F- <br />_ <br />