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the EivIrgreer, <br />CITY OF C INSTRUCTION <br />p C <br />everett PERMIT PERMIT NO. 17454 <br />259-8745 <br />EE BUILDING <br />❑ MECHANICAL <br />❑ PLUMBING[I SIGN <br />❑ DEMOLITION <br />❑ COMBINATION <br />MAIL ADDRESS <br />CITY <br />ZIP DNE <br />OWNER <br />D <br />EVEI>,1-'T 1A 9°23 <br />RICHARD BURCH <br />4 09 WEST \ITFW DRIVE <br />cTY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />❑Ty <br />ZIP PHONE IICENSE0 <br />GENERAL CONTRACTOR <br />MAIL ADOPE55 <br />_ _ _ _ _ _ <br />_ � . ...... n" 11 vc <br />CITY ZIP <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAII ADDRESS CItY ZIP PHONE • <br />CLASS OF WORN <br />rl NEW El AUDITION El ALTERATION El REPAIR El DEMOLITION <br />El BUILDING RELOCATION <br />s 10 000.00 <br />DESCRIBE WORK <br />New construction <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />LOT 33 BLOCK <br />E-11 <br />1 HEREBY CERTIFY THAT I 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 BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR_ AUTHORIZED AGENT, OR OWNER DATE _ <br />MECHANICAI <br />PLUMBING <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />A/C - A/HNDLG UNITS - H P. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS -H.P. EA <br />BATHTUB <br />BOILERS- P. <br />_— <br />LAVATORY IWASH 11ASIN) <br />'C UNITS <br />S <br />GASFIREDA..TS-flT.U. <br />_ <br />SHOWER <br />FORCED AIR SYSTEMS B T V M EA <br />KITCHEN SINK & DISP. <br />I <br />WAIL HEATERS -R.T.U. M <br />DISHWASHER <br />. �. <br />UNIT HEATERS - B I <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />I <br />CLOTHES DRYERS <br />— <br />- <br />URINAL <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />- <br />RANGE HOOD <br />FLOOR DRAIN <br />u . <br />- <br />WATER HEATER <br />BACKFLOW PREVENTERS <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />METAL FIflEPLACE 8 CHIMNEY <br />SINK (SERVICE - BAR. ETC) <br />FIREPLACEINSERT <br />HEAT PUMP _ <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />PERMIT <br />S <br />$ <br />TOTALFEE <br />TOTALFEE <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />86/17454 <br />76.05 <br />83368 <br />20' <br />20' <br />61 <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />V LUAT ON <br />FEE <br />R-1 <br />❑YES CkNO <br />BUILDING <br />5 <br />TYPE Of CON ST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />V_N <br />N <br />D <br />PLUMBING <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX. DEC. LOAD <br />MECHANICAL <br />1536 Sf <br />1 <br />INVESTIGATION FEE <br />Sec. 304(c) <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIRSD LJYES NO <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />O_ <br />Jef <br />�C <br />PERMIT VALIDATION <br />mm <br />WHEN PROPERL <br />L17 <br />wd- <br />t� <br />FUJi;i.S"- `ILI. <br />