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d�c L•rergmen /1 O�C���/1�I O�1 <br /> CITY OF � � V <br /> ever�ett PERMIT PERMIT NO. 1OH76 <br /> G7V NALI°59�87a5 <br /> EVERETT.WA sezoi ❑ COMBINATION X�IIS BUILDING ❑ MECHANlCAL ❑ pLUMBING <br /> OWNER �.IAllAU0BE55 CRY ZIV PMVML <br /> CATHERINE GORALSKI 3610 Upland Avenue Everett 98203 355-4603 <br /> ' APCIuIECi OP pESiGNFH MAR A�DRE55 QLY ZiP PMONL <br /> GENERFLCONiRACi0f1 MAILAD�RE55 QTY �IP PHONE LICENSE� <br /> Owner <br /> MECHANICALCONiFAC10fl AIAIIAOUR[55 CIiV ZIP PIIONE UCENS[I <br /> PWMBINGCONiPAGTOR IdpILADDRE55 QiY 2iP vhJN[ IiCLNSEI <br /> LlAS$OF WORY I <br /> ❑NEW ❑ADDITION ❑ALTERATION J�X�REPAIR ❑DEMOLITION ❑FENCE ❑SIGN L�GARAGE I <br /> VALUATION OF1 Nr'�GRM — <br /> 3 IGOO.00 <br /> oescnise wonK <br /> Reroof - wood shakes <br /> PnOPosEo u5E oF l3uiloiNG <br /> Residence I HEREBY CERTiFY THAT I HAVE READ AND EXAtdINED THIS AP- <br /> iecnioesce�arioHer i•i�orearvisHowec�owonanac�iFouawa�es� PLICATION AND KNOW THE £AME TO BE TRL'E AND CORHECT. <br /> 9 ALL PROVISIO�S OF LAWS ANO ORDINANCES GOVERNING THIS <br /> Ed ewater <br /> wr eic�rc_or TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NCT <br /> PRESUME TU GIVE AUTHORITY TO VIOLAT[OR CANCEL THE PRO- <br /> VISIONS OF ANY OTHER Sl'ATE OR LOCAL LAW REGULATING <br /> CONSTRUCTI�N OF THE PERFORMANCE OF CONSTRUCTION. <br /> �OB AD�RE55 SiCunivap pc Wtii�nCiCN P�AU��� .n[�G nG=_Ni DntE <br /> 3610 Upland Avenue � . � .Q�� g/�p�gp <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NG. T1.�E OF EQUIPMENT FEE <br /> WATER CLOS[T�TORET� :JR CONU.UNITS—HP.EA. <br /> BnTHTUB HLI�f91GERAT10N UNITS—H.B EA <br /> LAVATORY fWASH BASINI �pILERS—HP.EA. <br /> SHOWF.R GAS FlRED A.0 UNITS—TONN/.GE EA. <br /> KITCHEN SINK 8 DISP, FOPCEG AIR SVSTEMS—B7.0 M EA. <br /> DISHlVASHER �YALL HEATERS—O.LU. M11 <br /> LAUNORY TRAV UNIi NcATERS—B.T.U. M <br /> CLOTHES WASHER LVAPORATIVECOOLEflS <br /> WATER HEATER � CLOTHCS DRYEftS <br /> UPINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DPAIN AIR HANDLING UNIT— C.P.M. <br /> VACUUM PREAKERS STOVE <br /> ROO'ORAINS—RAINLEADERS METAL FlREPLACE B CHIMNEY <br /> SINK�SEFVICE—BAR,ETC! <br /> SUB TOTAI SU0 TOTAL f <br /> PERMIT S pERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> SIDE YARD S'eTBACH SiHCEI SLi BACk REA17 YARD SET�ACK PLFN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT ND. <br /> USF ZONE �OT AREA VACANT SITE <br /> �',YES i:NO FEES VALUATION FEE <br /> TVPL OF CANST. OCCUPANCY GROUP NO.OF DWEILING UNITS <br /> �UILDING b �2��.00 ZQ 5Q <br /> Si7F OF BLD3 NO OF SiORIES MAX.OCC LOAD <br /> PWMOING <br /> FIREZONE 6ASEMENT FIF[SPRINKltRS — <br /> REOUtRED MECHANICAL <br /> [1YES GNO <br /> APPROVALS BY OATE OTHER _� <br /> I. ENVIRONM[NTAL CHECK UST U.BC. <br /> PENA�T1' SFG 303(a) <br /> Z BUILDING PLAN$ . <br /> 3. FIRE HYDRANT TOTAL ZO SO <br /> a FIRE PROTECTION SYSTEM PEqMIT VALIDATIOIJ <br /> WHEN PROPLRLV VALIDATED�IN THIS SPACG)THI,S IS YOUR PcRMIT <br /> 5 GRADING <br /> q uJ <br /> 6 DRAINnGE 6 I 4 8 � O [ Q.�0 �""r��� <br /> 7. ENVIRCNMENTAL IMPACT STATF.MENT , � �Q <br /> P. H�ALTH DISTRICT n <br /> APPLICATION ACC.BV PLANS CHECKE�BY APPfi.FOR ISSUANCE BY _ YO U IR R E C F�/ T� <br /> s� � TH.ANK YOU <br /> n�,Ress r-i�e 1 7 pt1� $Z <br />