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�he £verRreen •� O N ST R U CTI O 11� � <br />uTv oF � <br />everett pERMIT PERMIT NO. 16�6�. <br />CITY NALI 259�87<5 <br />EVERETT, WA 98201 � COMBINATION Ix�( BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAII R��RESS CITY ZIP PMONE <br />ra,-olvn deramhart S6o7 c�„rt, ar� S1rpr=tt 982g�--2�-�674 <br />ARCHIT T OR DESIGNER MAIL /.pORE55 CTTY O <br />GENEPP� CONTRACTOP MAIL ADDRE55 CITY ZIP PMCNE 4CENSE I <br />MECMRNICAL CONTPACTOR MAIL RDDBESS CITY 21P PHONL LICENSE 1 <br />PLUMBING GONTHRCTOR MAIL A�DRE55 CItY 21P PMONE LICENSE � <br />OF <br />5 <br />O NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION (] FENCE ❑ SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />l0 �y�vBLOCN �.S_OF <br />PLUMBING <br />NO. TYPE OF �IXTURE OR ITEM <br />W ATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY�WASHBASIN) <br />SHOWER <br />KI7CHEN SINK 8 �ISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTMES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF DRAINS - FAINLEADERS <br />S�NK �SERVICE - BAR. ETG) <br />� <br />R-2 <br />V-N <br />IZE OF BLDG. <br />15' X 18' Addn <br />PERMIT <br />TOTAL FEE <br />EET SETBA <br />20' <br />AREA <br />:UPANCY G <br />R-3 <br />OF S70RIE <br />1 <br />APPROVALS <br />1. ENVIRONMENTAL CMECK LIST <br />2. DUILDING PLANS <br />$. FIRE MVDRANT _ <br />4. FIRE PRGiECTION SYSTEM <br />5. GRADING <br />fi. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />B. HEALTH DISTRICT <br />56 <br />FEE <br />�f <br />EAR VARD SETBACK <br />5' <br />ACANT SITE <br />YES X NO <br />O. OF OWELLING UN <br />1 <br />IAX.00C.LOAD <br />IRE SPRINKIEFS <br />EOUIREO <br />YES NO <br />BY DATE <br />PLANS CNECKED BY IAPPR.FOR <br />SG <br />LC <br />I HEREBY CERTIFY THAT 1 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 6E COMPLIEU 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 OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTIOJJ. <br />SIGNATl1REO�CONTF`AC,TOBOR/UTHORIZED�IGENT/ .,.p OATE <br />X - /% /J%.��f,/ . ��`� //.' JJ.' // .�' � /' ��7�� <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNIT.; — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALL MEATERS — B.T.U. M <br />UNIT HEATERS — 9.T.U. M <br />EVAPORATIVE COOLER3 <br />CLOTMESDFlVERS <br />VENTILATION FAN <br />HFNGEMOOD <br />AIR MANDLING �NIT — C.F.M. <br />STOVE — W000 <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />FEES <br />Code <br />rtt <br />Sl1B TOTAL 5 <br />PERMI7 f <br />TOTAL FEE f <br />PLAN CMECK FEE <br />FEE RECEIPT NO. <br />64.?�..�fi7d iQ <br />7 <br />VALUATION FEE <br />1 <br />UUIL�ING S 8����.0� 9� <br />PLUM9ING <br />MECMANICAL <br />OTHER �; <br />PENALTV � �� 9' �IIO4TS <br />TOTAL ZOI <br />WHEN PR PIERLVO ALIOATED pN�ACE� T}11ST�y0UR PERMIT <br />iriW <br />a+�ac iioo.so <br />BY <br />ADDR[SS 19Lti <br />.���i <br />1 <br />"_ i <br />(� <br />�-J <br />CO <br />t—{ <br />