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the LI er,r,•oi <br />everett <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 <br />4;ONSTRUCTIOt* <br />PERMIT PERMIT NO. 16240 <br />❑ COMBINATION ❑ BUILDING CX MECHANICAL ❑ PLUI.IBING <br />OWNER <br />MAIL ADDRESS <br />CITY <br />_iP <br />PHONE <br />Earl Crider <br />3207 Rucker Ave 41 <br />Everett <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />"'ONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE , <br />Natural Ga; Equipment <br />1625 E Marine View Dr <br />Everett, WA <br />98201 <br />258-2441 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE LICENSE <br />CLASS OF WORN <br />❑ NEW ®ADDITION ❑ ALTERATION ❑REPAIR ❑ DEMOLI110N ❑FENCE ❑SIGN ❑ WOOD STOVEIFIflEPLACE INSERT <br />1nsra1.A ua5 L,.Aj?—y <br />PROPOSED USE OF BUILDING <br />I 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 />LEGAL DESCRIPTION OF PROPERTY IS MOW BCLOW OR ATTACH FOUR COPIES) <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT -BLOCK -OF <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORKJANCE OF CONSTRUCTION. <br />SIGNATUR O CONi ACTOR OR AUi O U AGENT ATE <br />/J <br />JOB ADDRESS <br />3207 Rucker Ave #1 <br />X <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 />REFRIGERATION UNITS — H.P. EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS — M.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />SHOWER <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />KITCHEN SINK & DISP. <br />WALL HEATERS — B.T.U. M <br />DISHWASHER <br />UNIT HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />WAFER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT — C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE — WOOD <br />ROOF DRAINS — flA1NLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />1 <br />as i in <br />SUB TOTAL S <br />2 <br />OO <br />SUB TOTAL <br />3 <br />PERMIT $ <br />10 <br />OO <br />PERMIT <br />$ <br />TOTAL FEE $ 1 <br />TOTAL FEE <br />SIDE Yv.R7 SETBACK STREET SETBACK <br />f <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT 10. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />- <br />-:YES LINO <br />- <br />TVPE C.- CONSi. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />PLUMBING <br />5 <br />SIZE OF BLDG. NO. OF STORIES <br />MAX. OCC. LOAD <br />FIRE ZONE BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />12 <br />00 <br />YES NO <br />APPROVALS <br />BY OAT E <br />OTHER <br />— <br />U.B.C. <br />1. ENVIRONMENTAL CHECK LIST <br />PEN. LTY <br />SEC. 000 (a) <br />2. BUILDING PLANS <br />TOTAL 12 00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDtTION <br />WHEN I ROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />0 7 S 5 <br />n <br />•. �\',�_ i,� I_ I Pi <br />' <br />_ <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 •. ; )• 0 U <br />M.E1. <br />1 7 h;,a 86 <br />ADDRESS FILE <br />