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The Evergreen <br />CONSTRUCTIONCITY <br />OF <br />everett <br />PERMIT <br />PERMIT NO.06310 <br />CITY HALL 2598745 <br />EVERETT. WA 98201 ❑ COMBINATION L3 BUILDING MECHANICAL <br />U PLUMBING <br />OWNER <br />Brad Allurtsen <br />MAIL ADDRESS in <br />1824 Virginia <br />Zn' PHONt <br />252-5287 <br />ARCHITECT OR DESIGN[R <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE j <br />MAIL ADDRESS CITY <br />7303 Olympic Drive <br />GENERAL CONTRACTOR <br />SneffpyS Roofing <br />TIP <br />PHONE LICENSEI <br />98203 <br />355-4153 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE/ <br />CLASS OF WORN �'1 <br />❑NEW ❑ADDITION ❑ALTERATION M&PAIR ❑DEMOLITION nFENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />S 1424.00 <br />DESCRIBE WORK <br />composition re,roof <br />PROPOSED USE OF BUILDING <br />single family residence <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 VIOLATE OR CANCEL THE PRO. <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR TI iE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR FCONTAACIORORA THORIZEDAGENT DATE <br />X 6/29/79 <br />LEGAL DESCRIPTION OF PROPERTY(SHOW BELOW OR ATTACH FOUR COPIESI <br />21-22 361 Everett Div. P <br />LOT BLOCa_OF <br />_ <br />JOB A[1OA Virginia <br />l liL9 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS — H P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY ASH BASIN) <br />I <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS — TONNAGE FA. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEAT ERG —BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT —G,PM, <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />__ <br />TOTAL FEE f <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />[]YES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />f 1424 <br />15 <br />00 <br />SIZE OF BLDG. <br />NO, OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REOUIRED <br />DYES ❑NO <br />MECHANICAL <br />— <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />_ <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />15 <br />00 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLYVALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />8835 $ 015.00 .w 1, , <br />Cr) <br />(J, <br />YOUR RECEIPT C' <br />THANK YOU ' <br />6. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE ; 1 : ' 2 9JAI 79 <br />