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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 2598745 <br />EVERETT, WA 90201 <br />SCONSTRUCTIOW <br />PERMIT PERMIT NO. 12525 <br />❑ COMBINATION Xff BUILDING IJ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />SNOHOMISH COUNTY 3015 WFTMORF EIrLRFTT WA 98201 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE x <br />KIEIVIT CONSTRUCTION CO. 1300 Aloha snattlp WA g810g KIEIVICC179CS 624-8333 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />PLUMBING CO 4TRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />Demolish single family residence <br />PROPOSED USE OF BUILDING <br />Single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. 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 PRESUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATU E OF CONTRACTOR OR AUTHOR END AGENT DATE <br />X �3'Ll /�j cc:&<� l0 7 83 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT 13—BLOCK-7140F Everett Tqnrl CO <br />d:gfl_ 71 d- Q1j—Q.D <br />JOB ADDRESS <br />TXERYNTMUN 1905 - Pacific Avenue <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA, <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DIS'IWASHER <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 />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE — WOOD <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />.:YES :..NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />- --4- <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />YES NO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />00 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON T1j15 SPACE) THIS (IS YOUR PERMIT <br />[ 13 <br />!�F <br />� I <br />YOUR RECEIPT T <br />THANK YO U <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />6. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE 1 0 UCi 8) <br />