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., <br /> _ -� <br /> � ihe E�'ergreen r- ^,O N ST R U CT I O I� <br /> CitY oF <br /> everett PERMIT PERMIT NO. 121�.1 <br /> GTV MALL 259�8745 <br /> EVERETT,WA 98201 � COMBINATION GI�BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNER MAIL ADDRE55 CITY 21P PMONE <br /> Gordon Anderson 1408 Rucker <br /> ARCNITEGT OR DESIGNEH M11L l�DORES$ G�TY ZIP PHONE <br /> GENER�LCONTRACTOR MRIL�D�RE55 LITY ZIP PMONE UCENSEI <br /> Mel Forrey 7532 Lower Ridge Road Everett 98203 353-4659 <br /> MECM�NICAL GONTRRCTOR MRIL AODRESS GITV Z P PMONE LICENSE� <br /> FORREMJ322L4 <br /> PLUMBMG GONTR�GTOA MRIL RDORE55 GiTY i1P PMONE LIGENSE I <br /> � CLA55 OF WOPK <br /> ❑NEW O AODITION ❑ ALTERATION �EPAIR ❑ DEMOLITION ❑ FENCE �SIGN ❑ WOOD STOVFJFIREPLACE INSERT <br /> VALUATION OF WORK <br /> S 2�00�. �� <br /> DESCRIBE WORN <br /> repair bathroom <br /> PROPOSEDUSEOF BUIL�ING I HEREBY CEfiTIFY THAT I HAVE READ AND EXAMINED THIS <br /> single family residence qpp��CATION AND KNOW THE SAME TO BE TRUE AND <br /> LEWL DESCPIWION OF PROPERTY�SHOW BELOW OP RTiNCN FOUR COPIES) CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> 28-30 289 Everett Div. R GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> lOT_BLOCN__OF WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERMIT DOES NOT PRESUME TO CaIVE 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 /> SIG REOFCO TRACTOR RUTMOR2ED RGENT DATE <br /> '����'E�ucker X ' 6/20/83 <br /> PLUMB�NO MECMANICAL . <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERClOSET�TOILET) AIR COND.UNITS— M.P. EA. <br /> BATHTl1B REFRIGERATION UNITS— H.P.EA. <br /> LAVATORV IWASM BASIN) BOILEHS— H.P.EA. <br /> SHOWER GAS FIPED A.C.UNITS—TONNAGE EA. <br /> KITCMEN SINK 8�ISP. FOPCEO AIR SYSiEMS — 9.T.U. M EA. <br /> DISHWASHER WALL MEATERS— B.i.U. M <br /> LIUNDRY TRAY UNIT HEATERS— B.T.U. M <br /> CLOTMES WASNER EVAPORATIVE COOLERS <br /> N'ATER HEATER CLOTHES ORYERS <br /> UaINAL VENTILATION FAN <br /> D9INKING FOUNTAIN RANGE MOOD <br /> �FLO:�R DRAIN AIR HAN�LING UNIT— C.F.M. <br /> AGOUM BREAKEFS STOVE—WOOD <br /> ROOF ORAINS— RAINLEADERS METAL FIREPLACE 6 CHIMNEY <br /> SINK(SERVICE— BAR,ETC) FIREPLACE INSERT <br /> MEAT PUMP <br /> SUB TOTAL f 2 00 SUB TOTAL f <br /> PEfiMiT f PERMIT s <br /> TOTAL FEE f 2 00 TOTAL FEE f <br /> PLAN CHECK FEE <br /> SIDE YARD SETBACK STREET SET6ACK REAR YAflD SEiBACK PLAN CHECK NUMBEP FEE RECEIPT NO. <br /> USE ZONE L0T �REA VACANT SITE FEES VALUATION FEE <br /> �..YES �,.:NO <br /> TYPE OF COhS7. OCCUPANCY GROUP NO.OF DWELUNG UNITS <br /> BUILOING S 2 �0��. 32 S� <br /> SIZE OF BLOG. N0.OF STORIES MP%.OCC. LOAD <br /> PLUMBING Z OO <br /> FIREZONE BASEMENT qE�USRED KLERS MECMANICAL <br /> ', '.VES '.-NO <br /> BY D�TE �THER <br /> �PPHOVAlS U.B.C. <br /> 1.ENVIRONMENTAI CH CK LIST PENALTY SEC.30J(a� <br /> 2.BUILDINGPLANS u TOT�L 34 SO <br /> �.FIREHYDRANT � <br /> 4.FIRE PR T ION SYS EM PERMIT VALIDATION <br /> WHEN PPOPERLV VALIDATED�IN THISS2 POA;E)THI$I�YQUR PEROMIT � <br /> . �yS.GRAD o � n i 3 Z 5 <br /> • � p6.DRAI E ~ . �"� <br /> `G7 ENVI TALIMP , ST�TEMENT N <br /> 1�B.HEAL � ��T - YOU�R RECEIPT � <br /> W APPLIG/y� CC.BV � PLANS CHECKED BY APPR.FOR ISSUANCE BY T I-I AN K YO U <br /> Om . <br /> c � <br /> � 20 �t+ 83 <br /> ADDRESS FlLG � <br />