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the Evergreee CQ' 1 ST R U CT I O N <br />CITY OF: <br />everett PERMIT <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION DmILDING (] MECHANICAL <br />PERMIT NO. 07015 <br />U PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Peter Kruis 1906 Virginia 98201 259-4451 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />LICENSE / <br />Same <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE / <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WOHK yX�TT7� <br />❑NEW ❑ADDITION ❑ALTERATION 'TJ REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />E 500.00 <br />WORK <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 THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAT�U9��D/� CONTRACTOR ORA 1 RIZED AGENT DATE <br />X �.-!ti �z0 12/6/79 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIESI <br />29-30 386 Everett Div. P, <br />LOT BLOCK -OF <br />JOB ADDRESS <br />1906 Virginia <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H P. EA <br />BATHIJB <br />REFRIGERATION UNITS — FIR, EA <br />LAVATORY ASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.G. UNITS — TONNAGE EA. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B T.U. M EA, <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SUBTOTAL L <br />_ <br />PERMIT <br />S <br />PERMIT f <br />TOTAL FEE <br />S <br />OT <br />TOTAL FEE S <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 />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />_ <br />— <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />$ 500.00 <br />5 <br />00 <br />— <br />SIZE OF BLDG, <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS REOUIRED <br />❑YES <br />LINO <br />MECHANICAL <br />— <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.13C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />5 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATeD (IN THIS SPACE) THIS IS YOUR PERMIT <br />S 6 I O I (' 0 0 �• 0 0 „- t( <br />C <br />YOUR RECEIPT c <br />THANK YOU <br />5. 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 />I <br />